Turkish neurosurgery最新文献

Aim: To establish the diagnosis of basilar invagination (BI) on the basis of specific bony landmarks Klaus' index (KI), perpendicular distance between the tip of the odontoid process and palato internal occipital protuberance (PI) line.

Material and methods: Forty-nine patients were analysed, who underwent surgery for BI, between July 2020 and June 2023. Radiological assessment was done in all the patients using reconstructed midsagittal images on computed tomography scans .

Results: Mean age was 34.82 ± 10.52 years with male preponderance (67.35%) in patients with BI. We also analysed randomly selected 120 control subjects (male: female = 59:61) with mean age 43.5 ± 14.08 years. The mean distance of tip of the odontoid process from PI line in patients with BI was 3.39 ± 3.09 mm. The mean value of KI in the patients with BI was 28.57 ± 1.68 mm. Receiver operating characteristic (ROC)curve was used for analysing the distance of the tip of the odontoid process from PI line in the patients with BI which produced area under curve( AUC) of 0.97 (confidence interval [CI] -0.931 to 0.990, p < 0.0001). Cut-off point of 7.5 mm was identified for the distance of tip of odontoid process from PI line with sensitivity of 89.8% and specificity of 97.5% having 95.27% diagnostic accuracy for BI. ROC curve analysis of value of KI for the diagnosis of BI produced AUC of 1( CI: 0.978 to 1.000, p < 0.0001). Cut-off value of 33.2 mm for KI was identified for diagnosing BI with 100% accuracy.

Conclusion: The distance of tip of the odontoid process from PI line < 7.5 mm and value of KI < 33.2 mm, both of these parameters can diagnose BI with comparable accuracy to most widely used conventional radiological methods.

Aim: To compare the clinical and radiological results of patients who underwent multilevel posterior cervical fusion (PCF) with different end levels (C6 or C7).

Material and methods: We collected radiographs and clinical results of all subjects who underwent 3 level or more PCF for degenerative disease from May 2012 to December 2020. Based on the location of the end of fusion during surgery, patients were divided into C6 (group 1) and C7 patients (group 2). The clinical and radiological results of both groups were compared over two years.

Results: A total of 52 patients met the inclusion criteria of this study (21 in group 1 and 31 in group 2). The clinical results demonstrated a statistically significant difference with respect to a lower neck visual analog scale score in group 1 than in group 2 at the last follow-up (p=0.03). With regard to the radiological results, the C2-C7 sagittal vertical axis showed significantly greater values in group 2 than in group 1 at the final follow-up (p=0.02). For thoracic kyphosis (TK), group 2 had lower TK values than group 1 (p=0.03), and the T9 spinopelvic inclination was significantly greater in group 2 than in group 1 (p=0.01).

Conclusion: In this study, aggravation of cervical kyphosis and neck pain was observed when C7 was included in multilevel PCF surgery. The inclusion of C7 also affected the thoracolumbar parameters and global spine alignment.

Aim: To share our clinical insights into octogenarian patients with unruptured intracranial aneurysms (UIAs) and evaluate the treatment strategies for this demographic.

Material and methods: A retrospective analysis was conducted on data from 134 patients with a follow-up exceeding 6 months, all enrolled in this study. We assessed the incidence rates (IRs) of aneurysm growth and rupture, along with potential predictors of aneurysm growth.

Results: Among the 134 patients, 99 (73.9%) underwent conservative management, 25 (18.7%) received coiling, and 10 (7.5%) underwent clipping. The mean age of the cohort was 81.8 years. The middle cerebral artery was the most common location for aneurysms. The mean aneurysm size was 4.9 mm, with sizes significantly larger in the treatment groups (coiling and clipping) compared to the observation group (4.4 mm in the observation group; 5.9 and 7.4 mm in the coiling and clipping groups, respectively). The proportion of aneurysms with a daughter sac was higher in the treatment groups compared to the observation group (6.1% vs. 44% [coiling] and 50% [clipping]). The IR of aneurysm growth was 5.9 per 100 person-years, and that of aneurysm rupture was 0.8 per 100 person-years. No factors were statistically significant for aneurysm growth.

Conclusion: Age alone, especially in individuals over 80 years old, may not be a contraindication for UIA treatment. We recommend considering treatment in octogenarians with high-risk aneurysm features, such as a large aneurysm and the presence of a daughter sac, as the complication rates are low.

Aim: To describe the relationship between aneurysm size and location with the prevalence of headache at diagnosis and three- and six-month follow-up in a sample of patients with UIA.

Material and methods: In this cohort study, patients were diagnosed with UIAs by digital subtraction angiography (DSA). Follow-up visits occurred three and six months after the diagnosis. Headache presence was registered, and headache was further classified by phenotypes. After DSA, the recorded variables were aneurysm number, morphology, location, and size (diameter [W], neck [N], and dome-neck distance [H]). The aspect ratio (H/N) and the dome/neck ratio (W/N) were calculated. The outcome of this study was the self-reported headache status at follow-up.

Results: Data from 42 patients and 46 aneurysms were available; 81.0% of patients were women, with a mean age of 57.4±14.3 years. Headache was reported by 61.9% of the patients. The pain phenotype was tension-type in 38.1%, migraine in 11.9%, neuralgia in 2.4%, and unclassifiable in 9.5%. The median (min-max) measurements were W=5.05 (0.89-22.9); N=3.02 (0.52-17.9); H=5.08 (0.92-23.0); aspect ratio 1.59 (0.68-17.69) and W/N ratio 1.65 (0.62-16.92). Thirty-three patients (37 aneurysms) received treatment, 47.8% by surgical clipping and 32.6% by endovascular occlusion. In the treated patients, headaches had persisted in 14.3% until the first visit and in 9.5% until the second visit. There were no differences in any registered variables between patients with and without headaches at follow-up.

Conclusion: In this study, data was found that support that headaches in patients with UIAs improve after treatment and that such improvement is probably unrelated to the size and shape of the UIAs.

Aim: To investigate the therapeutic and neuroprotective effects of transcranial direct current stimulation (tDCS) application on the traumatic brain injury (TBI)-induced glutamate and calcium excitotoxicity and loss of motor and cognitive functions.

Material and methods: Forty rats were equally divided in the sham, TBI, tDCS + TBI + tDCS, and TBI + tDCS groups. Mild TBI was induced by dropping a 450-g iron weight from a height of 1 m onto the skull of the rats. The tDCS + TBI + tDCS group was prophylactically administered 1 mA stimulation for 30 min for 7 days starting 5 days before inducing TBI. In the TBI + tDCS group, tDCS (1 mA for 30 min) was administered 2 h after TBI, on days 1 and 2. Cognitive and locomotor functions were assessed using the novel object recognition and open field tests. The calcium, glutamate, and N-methyl-D-aspartate receptor 1 (NMDAR1) levels in the hippocampus were measured using enzyme-linked immunosorbent assay.

Results: Although the motor and cognitive functions were substantially reduced in the TBI group when compared with the sham, they improved in the treatment groups (p < 0.05). The calcium, glutamate, and NMDAR1 levels were considerably higher in the TBI group than in the sham (p < 0.001). However, they were considerably lower in the tDCS + TBI + tDCS and TBI + tDCS groups than in the TBI groups (p < 0.05). In particular, the change in the tDCS + TBI + tDCS group was higher than that in the TBI + tDCS group.

Conclusion: Application of tDCS before the development of TBI improved motor and cognitive dysfunction. It demonstrated a neuroprotective and therapeutic effect by reducing the excitotoxicity via the regulation of calcium and glutamate levels.

Aim: To report our institutional experience with full-endoscopic lumbar discectomy (FELD) and analyzed the pertinent literature.

Material and methods: We retrospectively enrolled 100 patients who had undergone full-endoscopic discectomy for lumbar disc herniation using either an interlaminar (IL) or transforaminal (TF) approach. All patients underwent pre-operative imaging. Before and after surgery, patients' pain and disability levels were measured using visual analog scale (VAS) and Oswestry disability index (ODI) respectively. Clinical outcomes were assessed using the modified MacNab criteria. Patients were divided into two groups, Group 1 (cases 1-50) and Group 2 (cases 51-100), and their learning curve factors were compared using a Student's t-test.

Results: Sixtynine cases were operated via an IL approach and the remaining 31 cases using a TF approach. There were 4 early conversions in microdiscectomy. The mean operative time of the 96 procedures was 57 min. In Group 1, the mean operative time was 61.7 minutes (range: 35-110); in Group 2, it was 52.3 minutes (range: 25-75). The difference between the two groups was statistically significant (p=0.009). No significant differences were found in conversions, early operations, and recurrences between Groups 1 and 2. Both groups experienced a significant reduction in postoperative VAS and ODI compared to preoperative scores.

Conclusion: The findings support previously reported information on the safety and effectiveness of the FELD. Herein, we share some practical tips and tricks based on our initial experience and on the review of the available literature, which could facilitate new users. In experienced hands endoscopic techniques make treatment of herniated discs feasible independently of patient age, anatomy, and/or targeted pathology features. Conversely, thoughtful patient selection and careful preoperative planning are highly recommended for new users.

Parsonage-Turner Syndrome, or neuralgic amyotrophy, is an acute-onset upper limb and shoulder girdle palsy that can occur in a post-viral, post-surgical or idiopathic setting. There have also been some reported cases of the syndrome occurring following vaccinations. The pathophysiology of neuralgic amyotrophy is not completely understood and many of the commonly used diagnostic imaging modalities we use to try and diagnose this syndrome are inaccurate and misleading. We present the case of a 40-year-old gentleman who presented with acute onset burning pain and fasciculations in his right upper extremity following vaccination with the second dose of the Pfizer-BioNTech COVID-19 vaccine. His symptoms progressed to weakness in isolated muscle groups with electromyographic evidence of decreased nerve conduction. MRI of the cervical spine demonstrated multilevel central and foraminal stenosis, suggesting a diagnosis of cervical radiculopathy. The patient underwent a C4-5/C5-6 and C6-7 laminoforaminotomy and tolerated the procedure well. Post-operatively, the patient has experienced gradual symptom improvement with residual right triceps and pectoralis muscle weakness as well as paresthesias of the right elbow and forearm. Parsonage-Turner Syndrome is a brachial plexus palsy that can affect one or multiple branches of the brachial plexus. It causes acute-onset pain and weakness, and the diagnosis can be difficult to make with the commonly used diagnostic imaging methods. We reviewed other case reports about neuralgic amyotrophy following vaccinations as well as the current literature on more accurate diagnostic imaging modalities that may help our diagnosis and understanding of the pathophysiology of this condition.

Aim: To highlight the critical role of molecular profiling of choroid plexus epithelium tumors (CPTs) in guiding individualized treatment strategies.

Material and methods: Histopathological diagnoses were obtained from surgically resected tumors at Centro Medico Nacional 20 de Noviembre, Mexico City (Department of Neurosurgery). The cohort comprised four children (two females and two males) and three adults (one male and two females).

Results: This study retrospectively analyzed data from seven patients diagnosed with CPT over a 5-year period. The pathological distribution consisted of three carcinomas, three papillomas, and one disseminated choroid plexus papilloma. Patient ages ranged from 1 to 62 years. All patients received chemotherapy, with four patients additionally undergoing radiotherapy. The median survival rate was six months, with one patient (carcinoma diagnosis) succumbing to the disease.

Conclusion: CPT, characterized by low incidence, present a significant clinical challenge. Histological grade remains the primary prognostic factor. Disseminated choroid plexus papilloma, an infrequent entity with limited reported cases, exhibits no response to radiotherapy. Moving forward, this field urgently requires the exploration of targeted molecular therapies and minimally invasive surgical approaches to address these rare and intricate tumors.

Aim: To evaluate coagulation related gene model as a biomarker for predicting prognosis of gliomas.

Material and methods: The mRNA expression and clinical data of glioma were downloaded from the TCGA and CGGA databases. Coagulation-related genes were downloaded from the KEGG database. The expression model was constructed using LASSO regression. The GBM data were divided into high and low-risk expression groups based on the median risk score, and the differences in overall survival and progression-free survival between them were calculated. The prognostic model was further validated using the TCGA-LGG and CGGA glioma databases, respectively. The accuracy of the risk score was calculated by ROC analysis for 1 year and 3 years.

Results: Four model genes, namely the SERPINA5, PLAUR, BDKRB1, and PTGIR, were identified, and the risk score was calculated as follows: risk score= SERPINA5*0.126264111304559 + PLAUR*0.288587629696211 + BDKRB1*0.349215422945011 + PTGIR*0.17334527969703, respectively. Based on glioma data from three groups, patients were divided into high and low-risk groups according to the median risk score. The overall survival, progression-free survival, and risk scores of the high-risk score group were worse than the low-risk group. The ROC curve analysis showed that the AUC values of the coagulation-related gene model at 1 year, 3 years, and 5 years were more than 0.65, validating the reliability of the prognostic model.

Conclusion: This study established the correlation between the coagulation-related gene model and glioma prognosis, providing deeper insight into the mechanism and treatment of glioma.