Turkish neurosurgery最新文献

Aim: Medulloblastomas (MBs) are the most commonly observed malignant brain tumors affecting children; they can be classified into molecular subgroups based on the 2016 and 2021 WHO classifications, as WNT-activated, SHH-activated and TP53-wild type, SHH-activated and TP53-mutant, and non-WNT/non-SHH. However, the molecular methods to determine these subgroups are not easily accessible for routine testing as they are expensive. Here, we investigated the efficacy of immunohistochemical methods to determine molecular subgroups and prognostic predictions of MB.

Material and methods: β-catenin, GAB1, YAP1, filamin A and p53 were immunohistochemically stained, and MYC and MYCN fluorescent in situ hybridization (FISH) procedures were applied to 218 cases in our series.

Results: Based on the histomorphological characteristics of the cases, 67.9% were deemed classic MB; 15.6% as desmoplastic/nodular medulloblastoma (DNMB); 12.8% as large cell/anaplastic (LC/A) MB; 3.7% as medulloblastoma with extensive nodularity (MBEN). Molecular characteristics revealed that 50.5% had non-WNT/non-SHH; 33.9% had SHH-activated and TP53-wildtype; 8.7% had WNT-activated; 6.9% had SHH-activated and TP53-mutant. According to the survival curves, LC/A MBs or non-WNT/non-SHH tumors showed the worst prognosis, whereas DNMBs and WNT-activated tumors showed the best prognosis. Classic MBs or SHH-activated tumors showed a moderate course. MYCN amplification was found to act as an independent poor prognostic factor in the study.

Conclusion: The distribution of histological subtypes and molecular subgroups, amplification rates, and prognostic data obtained through immunohistochemical methods in our study were consistent with those reported in the literature. It was therefore hypothesized that the determination of molecular subgroups by immunohistochemical methods can be useful in daily diagnostic practice, especially in centers with limited access to molecular techniques.

Aim: To share the surgical outcomes of 31 patients who underwent endoscopic endonasal transsphenoidal surgery (EETS) at a single center.

Material and methods: This retrospective analysis of 31 craniopharyngioma cases (2013-2022) with a minimum 6-month follow-up included demographic data, preoperative findings, postoperative resection volumes, recurrence rates, pathological diagnoses, and complications.

Results: Herein, 34 EETS surgeries were performed on 31 patients (12 males, 19 females). The presenting symptoms included visual loss (58%), hypopituitarism (54.8%), and diabetes insipidus (25.8%). Gross total resection was achieved in 87% of the patients, with 64.5% total and 22.5% near-total resection. Total resection prevented recurrences, contrasting with 75% recurrence in the subtotal resection patients (p=0.000). The primary patients showed 73.1% total resection, while only 20% of the recurrent patients achieved it (p=0.049). When comparing the first 16 cases with the last 15 cases in terms of surgical experience, the rates of resection (p=0.040) and recurrence-free survival (p=0.020) in the last 15 cases were statistically significant. Patients with preoperative visual loss demonstrated 94.4% improvement or stability postoperatively. Postoperative complications included hypopituitarism (71.4%), permanent diabetes insipidus (60.8%), worsening vision (6.5%), cerebrospinal fluid leakage (9.7%), meningitis (6.5%), and a 3.2% perioperative mortality rate.

Conclusion: This study underscores the role of surgical resection in craniopharyngiomas, emphasizing the impact of surgical experience on recurrence-free survival. Primary surgery, with minimal complications and maximal resection, is crucial in managing recurrence challenges. Endoscopic endonasal transsphenoidal surgery, particularly in experienced centers, offers advantages such as panoramic vision and access to the third ventricle base, facilitating total and near-total resection and extending recurrence-free survival.

Vagus nerve schwannoma is an infrequently occurring schwannoma, in which a distinct subtype exists wherein the tumor is confined to the cerebellomedullary cistern without invading the jugular foramen. This unique tumor is called purely intracranial vagal schwannoma. In this case report, we present a case of purely intracranial vagal schwannoma in its asymptomatic early phase, incidentally discovered during surgery performed on a patient with hemifacial spasm. Because of the small size of the tumor, we definitively recognized that it originated from the second rootlet on the caudal side. The tumor was totally resected uneventfully and a favorable prognosis was achieved. Furthermore, we conducted a comprehensive literature review to summarize the classification, origin, and surgical complications associated with this rare tumor type. Based on our literature review, we propose that: 1) the origin of tumor is related to the time of onset of symptoms, 2) nearly all purely intracranial vagal schwannomas can be entirely resected and favorable prognosis can be achieved, and 3) surgeons should be aware of potential cardiovascular complications during surgical procedures.

Aim: To identify the predictive factors associated with the survival of patients with a diagnosis of primary spinal cord lymphoma (PSCL).

Material and methods: The Surveillance, Epidemiology, and End Results (SEER) database was used in this study, which involved 254 patients with PSCL. Data on the patients' age, sex, race, pathology, Ann Arbor stage, adjuvant therapy, and year of diagnosis were collected. Univariate and multivariate Cox regression models were conducted to detect the predictive variables.

Results: Of the 254 patients, 67 (26.4%) die from lymphoma at the time of data collection. Cancer-specific survival at 1, 3, and 5 years was 81.0%, 74.6%, and 74.1%, respectively. Diffuse large B-cell lymphoma (DLBL) was the highest prevalent histotype (n=140, 55.1%). The multivariate Cox regression models revealed that chemotherapy (hazard ratio (HR): 0.47; 95% confidence interval (CI), 0.16-0.82; p=0.040) and radiochemotherapy (HR: 0.43; 95% CI, 0.10-0.57; p=0.045) were independent predictors of favorable cancer-specific survival, whereas age - 80 years (HR: 6.51; 95% CI, 1.65-25.64; p=0.003) and DLBL (HR:1.71; 95% CI, 1.02-2.88; p=0.030) were independently associated with poor cancer-specific survival.

Conclusion: The survival outcome of PSCL is favorable in the current treatment strategy. Chemotherapy and radiochemotherapy were predictors of favorable outcomes, whereas older age and DLBL were associated with poor prognosis.

Aim: To compare the preoperative and postoperative increased signal intensity (ISI) outcomes of cervical spondylotic myelopathy (CSM) patients who underwent posterior decompression and fusion, and to assess the correlation between ISI changes and postsurgical clinical prognosis.

Material and methods: The results from 123 patients were evaluated. In addition to demographic data, such as age and gender, factors, including body mass index (BMI); smoking history; duration of symptoms; follow-up periods; levels of decompression and fusion; comorbidities, such as diabetes, coronary artery disease, and hypertension; ISI grading; cervical sagittal vertical axis; C2-7 cervical lordosis parameters; and Modified Japanese Orthopedic Association (mJOA) scores, were statistically analyzed preoperatively and postoperatively.

Results: ISI improved in 39 patients (31.7%), remained unchanged in 53 patients (latent, 43.1%), and deteriorated in 31 patients (25.2%). There were no statistically significant differences in terms of age, gender, BMI, or levels of decompression and fusion between patients with ISI improvement, latent ISI, and worsened ISI. Patients with ISI improvement had the highest postoperative C2-7 lordosis values and shortest duration of symptoms. There was no statistically significant difference in the mJOA scores between patients with and without ISI improvement.

Conclusion: ISI improvement in CSM patients undergoing posterior cervical decompression and fusion is influenced by symptom duration and preoperative-postoperative cervical lordosis values. However, this study did not find a correlation between ISI improvement and clinical recovery based on the mJOA scores.

Aim: To examine the clinical characteristics and early rehabilitation results and to investigate the relationship between rehabilitation initiation time and rehabilitation-related outcome measurements in traumatic brain injury (TBI) patients who have early rehabilitation.

Material and methods: Forty-seven TBI patients who were referred for rehabilitation in the neurosurgery department were enrolled in the study retrospectively. Clinical characteristics and rehabilitation-related outcome measurements including consciousness, functional outcome, daily living activities, functional mobility, and ambulation of all patients were recorded. The paired samples t-test was used to compare data before and after rehabilitation. The relationship between rehabilitation initiation time and the other outcomes was analyzed with Pearson's correlation test.

Results: Most of the TBI patients were male (83%) and the severities of the trauma were mostly mild (42%). The causes of trauma were mostly falls (53%). Twenty-three (49%) of the patients underwent surgical intervention. The lengths of time between admission and consultation and between surgery and consultation were 19.82±17.9 and 14.24±15.4 days, respectively. The lengths of stay in intensive care and hospital were respectively 27.32±34.93 and 41.35±32.83 days. The rehabilitation time was 21.50±24.32 days. The before and after rehabilitation results showed that all rehabilitation-related outcome measurements improved significantly (p < 0.001). The relationship between rehabilitation initiation time and the other outcomes was statistically significant (p < 0.05).

Conclusion: This was a descriptive study in terms of demonstrating the demographic and clinical characteristics of TBI patients who need rehabilitation in the neurosurgery department. Early rehabilitation can enhance the rehabilitation-related outcome including consciousness, functional outcome, daily living activities, functional mobility, and ambulation in TBI patients as soon as their medical condition is stable. Early rehabilitation initiation time is important for improving the rehabilitation-related outcomes.

Aim: To assess the effect of intravenously injected superparamagnetic iron oxide nanoparticle (SPION)-labeled adipose-derived stem cells (ADSCs) under an external magnetic field on the efficacy of ADSC transplantation in rats with spinal cord injury (SCI).

Material and methods: ADSCs were isolated from rats, labeled with SPIONs, and divided into magnetic and non-magnetic groups. A rat model of SCI was established, and SCI rats were randomly divided into magnetic, non-magnetic, and control groups, with ten rats in each group. Rats in the magnetic and non-magnetic groups were injected with SPION-labeled ADSCs via the tail vein. A 300-mT neodymium iron boron magnet was placed externally at the SCI site of the rats in the magnetic group. One and two weeks after successful modeling, SCI rats were scored for the degree of SCI followed by histopathology of the spinal cord, number of ADSCs at the SCI site, and growth-associated protein-43 (GAP-43) expression were determined in the spinal cord tissues.

Results: One and two weeks after modeling, the Basso-beattie bresnahan (BBB) scores were the highest in the magnetic group, followed by the non-magnetic group, and the lowest in the control group. HE staining showed that the histopathological manifestations of the spinal cord in the magnetic group were somewhat improved compared to those in the non-magnetic and control groups. Two weeks after modeling, Prussian blue staining revealed that the number of ADSCs was significantly higher in the spinal cord tissue of the magnetic group than in that of the non-magnetic group. One and two weeks after modeling, western blotting revealed that the magnetic group exhibited the highest GAP-43 expression.

Conclusion: An external magnetic field applied at the SCI site in rats exerted a directional effect on SPION-labeled ADSCs, directing their migration and improving the efficacy of stem cell-targeted therapies for SCI.

Aim: To evaluate the cytotoxic and proapoptotic effects of C6 ceramide on the C6 rat glioma cell line.

Material and methods: The C6 rat glioma cell line was evaluated. Using a confocal microscope and the appropriate software, the cytotoxic effects of C6 ceramide were identified using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H tetrazolium bromide (MTT) colorimetric experiments. Transmission electron microscopy (TEM) was utilized to examine the ultrastructural changes following treatment with IC50 concentrations of C6 ceramide.

Results: Condensation and fragmentation of nuclei and DNA laddering was observed, indicating apoptotic cell death. C6 ceramide induced apoptosis and effectively caused cytotoxicity in the C6 glioblastoma cells. MTT assay demonstrated > 90% cell death after short-term application of C6 ceramide, confirming its apoptosis-triggering effect. Apoptosis was also confirmed via confocal microscopy and TEM.

Conclusion: Glioblastoma cells undergo apoptosis when exposed to C6 ceramide, which makes it a potential chemotherapeutic agent for the treatment of this aggressive brain cancer.