Turkish neurosurgery最新文献

Aim: The Transorbital and supraorbital minimally invasive approaches have been defined to reach intraorbital structures, adjacent sinuses, skull base, and other intracranial targets in this region. These approaches reduce the possible cosmetic and brain retraction-related morbidities caused by traditional transcranial approaches. Although these pathways are being studied endoscopically, a stereotactic approach has not been defined. The Kocher`s point and its surroundings, which are traditional entry points used in stereotactic surgery create compelling trajectories, carry a potentially higher complication risk for subventricular psychosurgical and hypothalamic targets. Herein, we aimed to evaluate the supraorbital and transorbital approaches as alternative entry sites and trajectories targeting the nucleus accumbens (NAc), subcallosal cingulate gyrus (SCG), and lateral hypothalamic area (LHA), in cadavers and surgical planning station.

Material and methods: The three-dimensional relationship of the identified trajectories within the anterior and middle cranial fossae as well as the stereotactically targeted NAc, SCG, and LHA, were demonstrated through dissection studies conducted in cadavers. To validate the accuracy of the measurements from the cadaver, trajectory planning was replicated using radiological imaging of patients without a space-occupying lesion who underwent gamma knife surgery. These measurements were compared with those from cadavers.

Results: The transorbital and supraorbital trajectories did not pass through the lateral ventricles and they can be used for subventricular targets. Additionally, the NAc and LHA can be targeted simultaneously. These trajectories pass along a broader anatomical area within the NAc due to the anatomical orientation of the nucleus.

Conclusion: These findings suggest that these entry points may offer new opportunities for stimulating different targets in the prefrontal cortex and may serve as an approach for future clinical use.

Aim: Latissimus dorsi is a multi-purpose muscle that can be used to repair defects in many areas of the body. The current study aims to investigate latissimus dorsi morphometry, innervation, vascularization, and variational situations in fetuses.

Material and methods: Forty-nine fetuses, aged between 15 and 40 weeks of gestation, were examined for the morphological development of the latissimus dorsi. The horizontal lengths of the thoracolumbar fascia, the dimensions of the latissimus dorsi and its tendon were measured. Additionally, the attachments of the latissimus dorsi and the branching pattern of the thoracodorsal nerve were evaluated. The development of all measured parameters during gestational age (trimester) and their interrelationships were assessed. Data were compared across sides (right and left) and genders.

Results: The study found that the increase in all parameters was proportional to gestational age. No significant differences were observed between sides or genders. The latissimus dorsi was directly attached (via muscle fiber) to the iliac crest in 60.2% of cases. An 88.5% attachment rate to the inferior angle of the scapula was noted, with 4.1% of these attachments being muscular. Additionally, 9.8% of latissimus dorsi tendons were found to adhere to the teres major tendon. The thoracodorsal nerve was observed to divide into 2 to 8 branches before entering the latissimus dorsi.

Conclusion: We believe this study will provide valuable insights into the development of intrauterine invasive fetal procedures for tendon, muscle, and nerve transfer repair and assist in determining the most appropriate timing for intervention.

Aim: The aim of this study is to investigate the effect of obesity on the treatment outcomes of lumbar transforaminal epidural steroid injections (TFESIs).

Material and methods: This retrospective study included patients who underwent single-level TFESI in a pain management center between January 2021 and April 2023. Body mass index (BMI) of the patients was evaluated based on the World Health Organization guidelines. Non-obese individuals had a BMI below 25 kg/m2, those with a BMI between 25 and 30 kg/m2 were classified as overweight, and those with a BMI greater than or equal to 30 kg/m2 were deemed obese. The Numeric Rating Scale (NRS) scores for all patients before the procedure, at the first hour, and at the one-month follow-up were documented. Treatment success was defined as a 50% or more reduction in NRS score at one month of follow-up.

Results: This study enrolled a total of 162 participants, with a mean age of 49.5 ± 13.7 years and an average BMI of 27.7 ± 4.36 kg/m2. The mean pre-procedural pain score was 8.3 (range, 4 to 10). Significant reductions were observed in the mean pain scores at the first hour (0.90) and first month (3.3), compared to the pre-procedural NRS scores (p .001). Upon categorizing patients based on BMI, no significant differences were observed among the groups regarding age, gender, symptom duration, procedure level, magnetic resonance imaging (MRI) grade, pain scores, and treatment success.

Conclusion: Since the potential effects of obesity on the short-term results of lumbar TFESI have not been elucidated yet, practitioners should continue to apply lumbar TFESI in patients with high BMI values.

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: The aim of this retrospective study was to investigate the morphology of sella turcica (ST) in Chiari malformation type I (CM-I) using computed tomography.

Material and methods: The size and shape of ST were examined using the radiological images of 32 CM-I patients (21 women/11 men, mean age: 26.09 ± 15.39 years) and 32 normal participants (19 women/13 men, mean age: 28.56 ± 19.37 years).

Results: The height, diameter, width, and length of ST were similar in CM-I and control groups (p 0.05). According to the Axelsson classification, the ST shape in CM-I was identified as normal in 16 patients (50%), oblique anterior wall in 2 patients (6.25%), irregularity in 6 patients (18.75%), and pyramidal shape of the dorsum sellae in 8 patients (25%). In controls, the ST shape was identified as normal in 18 patients (56.25%), oblique anterior wall in 4 patients (12.50%), irregularity in 2 patients (6.25%), and pyramidal shape of the dorsum sellae in 8 patients (25%). According to the Camp classification, the ST shape in CM-I was identified as oval in 6 patients (18.80%), round in 21 patients (65.60%), and flattened in 5 patients (15.60%). In controls, the ST shape was identified as oval in 19 subjects (59.40%), round in 10 patients (31.30%), and flattened in 3 patients (9.40%).

Conclusion: The size of ST in patients with CM-I was similar to that in healthy partcipants. The only difference in ST morphology was that patients with CM-I had more round-shaped sella, whereas normal subjects had more oval-shaped sella.

Aim: The aim of this study is to assess associated cerebral supratentorial anomalies in patients who underwent myelomeningocele repair in hopes of developing a better morphological apprehension of the forebrain's anomalies in this category of patients.

Material and methods: This retrospective observational study assessed 426 pediatric patients who underwent myelomeningocele repair between January 2013 and December 2020. Cranial MRIs with T1- and T2-weighted sequences were obtained as part of the postoperative assessment to determine the presence of associated supratentorial anomalies in pediatric patients following myelomeningocele repair.

Results: The most common supratentorial anomalies identified in patients who underwent myelomeningocele repair are associated with the configuration of the corpus callosum (CC). Moreover, the complete agenesis of the CC was noticed in 9 (2.1%) subjects, whereas partial agenesis was identified in 148 (34.7%) subjects. Hypoplasia of the CC was observed in three (0.7%) patients. Gray matter heterotopia were the second most commonly observed supratentorial anomalies in 110 (25.8%) patients. Furthermore, the absence of the septum pellucidum was observed in two (0.47%) of the total patients. The widening of the interhemispheric fissure and abnormal maturation of the white matter were observed in 10 (2.34%) patients and 11 (2.58%) patients, respectively. Polymicrogyria, a consequence of abnormal cortical organization, was identified in 22.53% of the patients (96 patients) included in our series.

Conclusion: This study confirms that, except for hydrocephalus and Chiari malformation, other associated cerebral supratentorial anomalies may be observed in patients with myelomeningocele. However, only limited research has confirmed the interconnection between the cerebral supratentorial anomalies and cognitive function. Therefore, this study emphasizes the necessity for further supplementary studies, in conjunction with accurate postnatal followups, in order to assess the real significance and repercussions of these anomalies on neurological development and also to establish how these structural changes in brain anatomy translate clinically.

Aim: We investigated the short- term results of dynamic/semi-rigid stabilization in patients with cervi-cal spinal stenosis and compare them with patients for which decompression and posterior cer-vical fusion was performed.

Material and methods: 28 patients were included in this study. Group 1 was the semi-rigid group (four male, ten fe-male), 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 re-garding 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 pa-thologies 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 outcomes as pos-terior 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: St. John's Wort Oil (JWO) has a sedative property and it is used traditionally for the treatment of depression, neuralgia and excitability. JWO has been shown to have anticancer activity via apoptosis in glioblastoma cells. However, information on whether JWO is effective on the autophagy mechanism in glioblastoma is still not known. So, the current study was the first to search the autophagy mechanism T98 glioma cells.

Material and methods: Three groups were created with T98 human glioblastoma cells; Group 1: T98 glioma cells with no treated (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.

Aim: Minimally-invasive spinal surgery is increasingly being adopted worldwide. In this study, we evaluated the postoperative magnetic resonance imaging (MRI) findings and clinical outcomes of patients who underwent full endoscopic lumbar disk surgery.

Methods: Preoperative and postoperative 3rd and 6th month MRI features, visual analog scale (VAS) score, Oswestry Disability Index (ODI), and clinical features of patients who underwent percutaneous endoscopic lumbar discectomy between August 2009 and January 2012 were retrospectively analyzed.

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

Results: 65 patients (37 women, 28 men) were included in the study. VAS and ODI scores showed significant improvement postoperatively (p 0.001). Intervertebral disk height loss was observed only in two patients. In 31 (48%) out 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 these 3 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 only 3 levels demonstrated grade 3+ changes; 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.

Aim: Many combinations of inflammation-based markers have been reported their prognostic ability. The prognostic value of albumin-to-gama-glutamyltransferase ratio (AGR), an inflammation-related index, has been identified for several cancers. However, the predictive value of AGR for high-grade glioma patients remains unclear. As a result, this study was conducted to assess the prognostic value of AGR in high-grade glioma patients (WHO III and IV) and 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 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.