Turkish neurosurgery最新文献

Aim: Large language models (LLMs) are being used more often in medicine, but their impact on neurosurgical education is not well studied. To our knowledge, this study is the first to evaluate Deepseek-R1, Gemini-2.0 Pro, ChatGPT-o3-mini-high, and GPT-4.5 on a mock neurosurgery board exam to assess their accuracy and educational value.

Material and methods: We created a 50-question mock neurosurgery board examination and administered it to three major LLMs and 10 Turkish senior residents. Next, we systematically evaluated their responses for accuracy, reasoning time, word count, and readability. Residents ranked the educational value of the LLM responses. The study also compared two recent ChatGPT versions, o3-mini-high and GPT-4.5, using the same test. Statistical comparisons were used to analyze the results.

Results: In overall accuracy, all three LLMs achieved higher scores than residents, with Deepseek-R1 at 84%, ChatGPT o3 mini-high at 82%, and Gemini 2.0 Pro at 78%, compared to 58% for residents (p 0.001). Deepseek-R1 required the longest reasoning time but provided the most organized responses. Gemini-2.0 Pro produced the most detailed and easy-to-read answers. Residents preferred the explanations from Deepseek-R1 and Gemini-2.0 Pro over those from ChatGPT-o3-mini-high (p 0.001). ChatGPT-4.5 achieved 74% accuracy, higher than residents but lower than other LLMs. Compared with ChatGPT o3-mini-high, ChatGPT-4.5 produced longer, more complex responses while responding faster (p 0.001).

Conclusion: LLMs' higher scores on the mock board examination highlight their potential as auxiliary educational tools in neurosurgical training. The high accuracy of Deepseek-R1 and the clarity of Gemini-2.0 Pro's detailed responses suggest uses with refinement as neurosurgical educational guides or in constructing board questions or training assessments.

Aim: This study aimed to investigate corpus callosum shape differences in pediatric hydrocephalus patients with and without shunt revisions.

Material and methods: Midsagittal magnetic resonance imaging images from 45 cases (25 with and 20 without shunt revision surgeries) that underwent ventriculoperitoneal shunt surgery between 2016 and 2025 were retrospectively analyzed. Corpus callosum shape deformations were evaluated using thin plate spline (TPS) analysis. Landmark-based geometric morphometric methods were applied, and growth curve modeling was used to assess the relationship between centroid size and the number of shunt revisions.

Results: TPS analysis revealed that patients with multiple shunt revisions exhibited the most prominent corpus callosum deformations in the posterior region. Atrophy was detected mainly in the splenium region.

Conclusion: This study identified changes in the corpus callosum of pediatric hydrocephalus patients with multiple shunt revisions compared to those without shunt revisions. These findings may help characterize the clinical features of cases with multiple shunt revisions.

Aim: This study aims to evaluate the complications associated with Unilateral Biportal Endoscopy (UBE) in spinal surgery, highlighting the risks and outcomes of this minimally invasive approach.

Material and methods: A retrospective analysis was conducted on 374 patients who underwent UBE at three centers from 2022 to 2023. The study included cases of lumbar disc herniation, recurrent disc herniation, and lumbar stenosis. All procedures were performed by experienced surgeons, with a minimum postoperative follow-up of one year for each patient.

Results: A total of 374 patients were included: 224 underwent UBE discectomy, 115 underwent UBE decompression for lumbar stenosis, and 35 underwent surgery for recurrent herniation. Overall, 178 patients (47.5%) were female and 196 (52.4%) were male. Complication rates differed across cohorts: 19 complications occurred in primary discectomy cases (8.4%), 12 in stenosis cases (10.4%), and 5 in recurrent cases (14.2%). The most common complications were dural tear (n=8), recurrence (n=7), and root injury (n=6). Less frequent events included retinal hemorrhage (n=2) and hydroperitoneum (n=1).

Conclusion: The findings suggest that while UBE is generally safe, it is associated with a notable complication rate, including dural tears and root injuries. Continuous efforts to refine surgical techniques and enhance training may further mitigate these risks, ensuring better patient outcomes.

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.

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.

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.

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 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.

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.