Turkish neurosurgery最新文献

Aim: To evaluate the in vitro effects of hydroxychloroquine (HCQ) on histone deacetylase (HDAC) enzyme activity and interleukin (IL)-6, IL-10, and tumor necrosis factor-alpha (TNF-α) expressions.

Material and methods: Primary cell cultures were prepared. Samples that did not receive any medication constituted the control group, while culture samples treated with HCQ served as the study group. The surface morphology of cells and the extracellular matrix (ECM) were evaluated by Giemsa staining and inverted light microscopy. Cell viability, proliferation, and cytotoxicity were determined by 3-(4,5-dimethylthiazol2-yl)-2,5-diphenyltetrazolium-bromide (MTT) analysis. The cultures were simultaneously stained with acridine orange (AO)/propidium iodide (PI) and viewed under fluorescence microscopy. HDAC enzyme activity and IL-6, IL-10, and TNF-α expression were evaluated using commercial enzyme-linked immunosorbent assay kits. The obtained data were analyzed using statistical methods. The alpha significance level was accepted as p < 0.05.

Results: HCQ applied to cell cultures at the tested doses and durations showed cytotoxic effects on cell viability, proliferation, and cell or ECM morphology. It increased HDAC activity in chondrocytes and caused a proinflammatory response, indicated by an increase in TNF-α in the cells (p < 0.05).

Conclusion: The results of this study emphasized that the cytotoxic effect of HCQ increased HDAC activity; therefore, this proinflammatory response should be taken into consideration in the clinical use of HCQ.

Aim: 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 female/11 male, mean age: 26.09 ± 15.39 years), and 32 normal participants (19 female/13 male, 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: To assess the changes of intracranial pressure waveforms (ICPW) acquired noninvasively in a set of acute hydrocephalus patients prior to and posterior to interventions.

Material and methods: Patients with clinical and radiological diagnosis of hydrocephalus were evaluated for alterations in ICPW by means of a system that detects cranial micro expansions just before and immediately after interventions. The system quantified the difference between ICPW peaks (P1 and P2), providing the P2/P1 ratio.

Results: Fourteen patients aged from 26 to 73 years old met the inclusion criteria. Hydrocephalus etiologies were normal pressure hydrocephalus, post-traumatic and all patients had an abnormal intracranial compliance waveform, with P2 > P1 before the procedure (5 external ventricular drains (EVD) and 9 ventriculoperitoneal shunts (VPS). Immediately after, 75% of the patients changed to a standard pattern with P1 > P2.

Conclusion: In this exploratory study using a novel noninvasive technique, rapid cerebrospinal fluid drainage by means of EVD and VPS was effectively assessed and had a positive impact on intracranial compliance.

Aim: 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: 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.

Aim: To examine the potential of transbrachial access (TBA) in carotid artery stenting (CAS).

Material and methods: This systematic review and meta-analysis aimed to comprehensively evaluate the safety and efficacy of TBA for CAS by conducting a thorough search on Medline, Cochrane Library, Embase, and Web of Science databases. Studies reporting TBA for CAS and evaluating primary outcomes such as good neurological results, procedural success, and complications were included. Studies with fewer than 4 patients were excluded.

Results: After a meticulous selection of 1837 literature articles, 11 studies were meticulously chosen for the comprehensive examination, involving a total of 273 patients. The analysis of nine studies revealed a consistent 100% procedural success rate with minimal variability (95% CI: 98% to 100%). In the final assessment of neurological status across eight studies, good neurological outcomes were observed in 99% (95% CI: 98% to 100%). Additionally, nineteen complications were identified, leading to a 1% rate (95% CI: 0% to 9%). Among the 223 patients in eight studies, resulting in a pooled estimate of 0% mortality (95% CI: 0% to 1%), indicating a favorable safety profile.

Conclusion: The results of TBA for CAS demonstrate a highly effective and safe procedure. Despite the limitations, TBA can be an option in patients with no other access available, and further comparative studies are required to establish definitive conclusions.

Aim: 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: 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: To investigate the effects 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.