Turkish neurosurgery最新文献

Aim: To explore interrelationships between serum lactate (Lac) levels and other hemodynamic parameters, including diastolic blood pressure (DBP) and mean arterial pressure (MAP) and acute-phase mortality in severe traumatic brain injury (sTBI).

Material and methods: Clinical data for sTBI patients (Glasgow Coma Scale (GCS) score ?8 on admission) were collected from different hospitals from 2013 to 2024. One-week mortality was the endpoint. The associations of all blood pressure (BP) indices and Lac levels with one-week mortality were investigated using mixed effects logistic regression models, and the diagnostic value of mortality analysis based on the Lac levels was evaluated via receiver operating characteristic (ROC) curves and areas under the curve (AUCs). In addition, the relationships between the BP indices and Lac levels were assessed by linear regression analysis.

Results: A total of 1270 sTBI patients were analyzed in this study. Bivariate analysis revealed smooth U-shaped associations of different BP indices upon admission with one-week mortality, and extreme values of the BP indices were found to be associated with increased mortality, with no obvious threshold effect revealed. After adjustments were made for confounding factors, the likelihood of death clearly increased with a SBP < 100 mmHg, a DBP < 70 mmHg, a MAP < 80 mmHg and a Lac > 4.5. Furthermore, all three BP indices were significantly negatively correlated with Lac levels. Moreover, MAP has the strongest ability to predict oneweek mortality in sTBI patients, and it also has the strongest negative correlation with Lac levels.

Conclusion: In the development of guidelines for managing sTBI patients, the definition of hypotension should be reconsidered, and all three BP indices and serum Lac levels should be used as references instead of a single hypotension index of SBP < 90 mmHg to improve the survival rate.

Aim: To compare central nervous system (CNS) tumors, such as paraganglioma, low-grade glioma (LGG), and glioblastoma (GBM), in terms of driver genes and gene expression, and to investigate the roles of common driver genes and genes with altered expression in cellular proliferation mechanisms and their interactions.

Material and methods: Mutation datasets for pheochromocytoma/paraganglioma, LGG, and GBM from The Cancer Genome Atlas (TCGA) database were used for driver gene prediction. Six datasets from the Gene Expression Omnibus (GEO) database were used for differential gene expression analysis. A hybrid approach combining clustering and computational biology methods was applied to identify driver genes. Gene expression analyses were repeated for two gene expression datasets for each tumor type, and the intersection of the results was taken. Protein interaction analyses, overall survival analyses, and carcinogenesis-related functional analyses were performed on the common driver genes and the genes with the most significant changes in expression.

Results: ATRX, NF1, MUC16, and TTN were identified as driver gene candidates for all three tumor types. FSTL5, GABRG2, VSNL1, and LPL were found to be the genes with the most altered expression across all tumor types. Our findings suggest that, while CNS tumors with similar symptoms share molecular features, they can be more accurately differentiated through detailed investigation of the expression and mutation burden of the identified genes. This may also help accelerate the treatment planning process.

Conclusion: This study confirms that paraganglioma, LGG, and GBM may share common mutational and expressional gene patterns. The identified genes may serve as potential therapeutic targets in the treatment of glial and neuroendocrine tumors.

Non-neoplastic intracranial cysts (NICCs) are usually stable and typically do not cause symptoms throughout life. Among the various NICCs, rare spontaneous disappearances of arachnoid cysts, colloid cysts, and Rathke?s cleft cysts in various locations have been reported. To our knowledge, no reports to date have described spontaneous disappearance of choroid plexus cysts (CPCs). We here report the first case of spontaneous bilateral disappearance of CPCs. Although the exact pathogenic mechanisms remain unclear, we believe that a sudden transient change in intracranial pressure or cerebrospinal fluid circulation plays an important role in the bilateral disappearance of CPCs. Further research is warranted to clarify this rare phenomenon.

In recent years, there have been multiple reports of delayed leukoencephalopathy (DL) occurring after endovascular treatment for cerebral vascular lesions, with polyvinylpyrrolidone (PVP) identified as a contributing factor. Herein, we present a case of DL developing after coil embolization for an unruptured aneurysm, and following the implementation of measures, we subsequently performed repeat endovascular treatment. A 65-year-old female with a history of bronchial asthma underwent coil embolization using the double catheter technique for the right internal carotid artery-anterior choroidal artery aneurysm. One month postoperatively, she developed DL accompanied by left hemiparesis, which improved with steroid pulse therapy. Investigation into the cause of DL revealed elevated anti-nuclear antibodies, leading to a diagnosis of Sjögren?s syndrome and Hashimoto?s disease. Additionally, metal patch testing yielded negative results. At the 1-year follow-up, an enlargement of a known basilar top aneurysm prompted the decision to perform stent-assisted coil embolization. To prevent peripheral scattering of PVP during the procedure, the decision was made to perform all imaging along a different axis guided by a catheter. Despite complications such as stent thrombosis, with no reduction in contrast agent usage, imaging frequency, or surgical time compared to the initial treatment, DL did not manifest in the postoperative course. For the prevention of DL after endovascular treatment, from a procedural aspect, it is important to reduce the peripheral dispersal of PVP that occurs during treatment. Performing angiography during treatment from a separate axis catheter may be a useful strategy in preventing the development of DL.

Aim: To determine if the concurrent use of external lumbar drainage (ELD) and oral medication will hasten the decrease in intracranial pressure (ICP) and resolution of papilledema in pediatric idiopathic intracranial hypertension (IIH).

Material and methods: In this retrospective study, we evaluated the outcome of pediatric patients with IIH who underwent ELD as an adjunct treatment to standard oral medications. All patients underwent ophthalmological examination, optic coherence tomography, retinal nerve fiber layer thickness assessment, and ICP measurements before and after ELD. The outcome was evaluated via serial ophthalmological examinations, optical coherence tomography to measure retinal nerve fiber layer thickness, and lumbar puncture to measure ICP.

Results: Eleven pediatric patients (7 females, 4 males) were enrolled in the study. The mean age of the patients was 10.9 ± 4.4 years (range, 5.6?17.7 years). The mean cerebrospinal fluid opening pressure was 447 ± 112.5 mm H2O before ELD. The mean post- ELD ICP was 263.1 ± 92.4 mm H2O. The retinal nerve fiber layer thickness at the time of diagnosis was 200.9 ± 113.7 ?m and 212.6 ± 123.3 ?m in the right and left eyes, respectively. After ELD, the thickness was 149.4 ± 45 ?m and 151.4 ± 51.3 ?m in the right and left eyes, respectively. The mean duration of ELD was 8.7 ± 1.4 days (range, 7?10 days). The post-ELD cerebrospinal fluid opening pressure and retinal nerve fiber layer thickness were significantly lower than pre-ELD values. Four patients required lumboperitoneal shunt surgery during follow-up.

Conclusion: Proactive ELD is an effective method to achieve a rapid decrease in ICP and retinal nerve fiber layer thickness without major complications.

Aim: To perform comparison of preoperative and postoperative mean transit time (MTT) delay in ipsilateral, and contralateral hemispheres in Moyamoya disease using dynamic susceptibility contrast (DSC) perfusion.

Material and methods: Preoperative images were obtained within 1 week before surgery and postoperative images were taken 3 months after surgery. Cerebral perfusion was assessed in bilateral middle cerebral artery territories with 3 Region Of Interest (ROI) on each side (ipsilateral and contralateral to surgery side). Two ROI were also drawn in bilateral cerebellar hemisphere. MTT delay at each middle cerebral artery (MCA) region was calculated by subtracting MCA territory ROI MTT value from ipsilateral cerebellar ROI MTT value. Non-normally distributed measurement data are expressed as the median [interquartile range (IQR)] and compared using Wilcoxon?s rank-sum test. p < 0.05 was considered statistically significant.

Results: Median ipsilateral MTT delay values (in seconds) before surgery were 2.4, Interquartile Range (IQR) 4.95; and after surgery was 1, IQR 2.1 We noted a significant decrease in postoperative MTT delay values on ipsilateral side compared with preoperative values (p=0.008). Contralateral MTT delay values did not show this trend. Median contralateral MTT delay values (in seconds) before surgery were 0.6, IQR 3.7; and after surgery was 1.6, IQR 3.65 We noted no significant difference in preoperative and postoperative MTT delay values on contralateral side (p=0.12).

Conclusion: DSC perfusion analysis of MTT delay in follow up imaging after revascularization surgery can be helpful in deciding success of surgery. Evaluation of contralateral hemisphere perfusion can be helpful to guide regarding need of contralateral side surgery. Future studies to evaluate contralateral perfusion characteristics are necessary to understand the complex hemodynamic changes which occur post revascularization surgery.

Aim: To investigate the difference in the length of C1 laminectomy between the right and left sides and to determine the importance of considering the dominant vertebral artery in reducing complication risks.

Material and methods: Five caucasian male cadavers were studied. The distance of the C1 posterior tubercle to the vertebral groove (A), the length of the vertebral groove (B), and the diameter of the vertebral artery were measured and statistically investigated. Computed tomography scans were also obtained from all cadaver specimens.

Results: The mean distance of the C1 posterior tubercle to the vertebral groove (A) on the right side was 20.20 ± 2.16 mm and on the left side was 16.40 ± 2.88 mm. The mean distance of the vertebral groove (B) on the right side was 13.80 ± 0.83 mm and on the left side was 17.60 ± 0.89 mm. The mean diameter of the vertebral artery on the right side was 3.58 ± 0.83 mm and on the left side was 3.70 ± 0.10 mm.

Conclusion: The vertebral groove was longer on the dominant artery side. Therefore, the dominant and nondominant sides have different lengths of safe C1 laminectomy areas. The length of the laminectomy area to be performed on the dominant artery side is shorter than that on the nondominant side. In cases in which the C1 posterior arcus must be removed for decompression, asymmetric decompression should be performed to reduce the risk of vertebral artery injury.

Aim: To investigate the protective and therapeutic effects of dexpanthenol in experimental global cerebral ischemia-reperfusion injury.

Material and methods: Thirty-two female Wistar-Albino rats were used, and the rats were divided into four groups (sham, sschaemia reperfusion [IR], IR+dexpantol [IR+DXP] and DXP+IR), with eight animals in each group. At the end of 72 hours of reperfusion, the rats were decapitated after performing the rotarod and accelerrod tests, their brain tissues were removed and histopathologically examined, and superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), glutathione (GSH), and malonyldialdehyde (MDA) levels were evaluated.

Results: In this study, motor skill functions deteriorated in the ischemia-reperfusion (IR) group compared to the sham group, while significant improvements were observed in both the IR+DXP and DXP+IR groups (p < 0.05). There were no notable differences in CAT, SOD, and GPx enzyme levels among the groups (p > 0.05); however, malondialdehyde (MDA) levels increased in the IR group and decreased significantly in the IR+DXP group (p < 0.05). Similarly, glutathione (GSH) levels were lower in the IR group but higher in the IR+DXP group (p < 0.05). Neuronal degeneration also significantly increased in the IR group but decreased in the IR+DXP group (p < 0.05).

Conclusion: Overall, these findings suggest that dexpanthenol has a neuroprotective effect, particularly when administered during reperfusion, effectively improving motor skills and reducing neuronal damage.

Aim: To identify the autophagy mechanism T98 glioma cells.

Material and methods: Three groups were created with T98 human glioblastoma cells; Group 1: T98 glioma cells without treatment (Control group). Group 2: T98 glioma cells treated with 3 µl/ml JWO. Group 3: T98 glioma cells treated with 6 µl/ml JWO. The cell proliferation, oxidative stress, types of cell death were studied at IC50 dose of JWO.

Results: The proliferation of glioma cells was inhibited in 5.296 µl/ml dose. JWO induced apoptosis in T98 glioma cells in comparison with the control and there was statistically significant difference (p < 0.001). Apoptosis was analyzed via TUNEL method and results were checked by flow cytometry. We also investigated the effects of JWO on autophagy in T98 glioma cells by immunostaining LC3-II and MDC fluorescent stainings. The differences between JWO treated and control group were notably significant (p < 0.001). The immunofluorescence staining resultsof LC3-II was confirmed by Western blotting analysis.

Conclusion: JWO seems to be an effective treatment agent for glioblastoma. Not only does it induce apoptosis via oxidative stress but also affects the autophagy. The use of JWO in combination with other treatment options may increase the efficacy of treatment.