Turkish neurosurgery最新文献

Aim: The anterior endoscopic transcervical approach (AETCA) is a novel surgical technique developed to address the limitations and risks associated with traditional transoral and endonasal approaches for odontoid process pathologies. This study aimed to evaluate the anatomical features, limitations, and technical aspects of AETCA using a cadaveric model.

Material and methods: The study utilized nine human cadaver heads sectioned at the C6-7 level, fixed in 10% formalin for at least four weeks. A 0? endoscope and drills were employed for odontoid resection. The extent of resection was calculated volumetrically using pre- and post-procedure CT imaging. Fluoroscopy was used for orientation, and the resection was evaluated volumetrically using pre- and post-procedure CT imaging.

Results: An average dens resection rate of 54% was achieved across the cadavers. Total resection was achieved in two cadavers, subtotal in two, and partial in five. Angled drills resulted in significantly higher resection rates compared to flat-end drills. No major vascular or neural injuries were observed. Extension to the posterior wall of the odontoid was achieved in 7 cadavers. The long and narrow surgical corridor and the difficulty of midline orientation posed challenges, but these were mitigated using a specially designed tubular trocar.

Conclusion: AETCA provides significant advantages, including reduced postoperative infection risks, shorter hospital stays, and lower morbidity and healthcare costs. Our findings indicate that technical proficiency and improved equipment are critical for success, particularly in achieving complete odontoid resection while preserving surrounding structures. AETCA is a promising alternative for odontoidectomy, offering improved safety and efficiency. This study provides insights into the technical and anatomical considerations of the procedure, aiming to guide future clinical applications and reduce the learning curve.

Aim In this study, we operated 22 patients with brainstem tumors between 2010 and 2023 and compared our results with the existing literature, thereby sharing our knowledge and experience in managing brainstem tumors. Materials and Methods We performed surgery on 22 patients with brainstem tumors using various approaches to access the pathology. Our goal was to achieve total or gross total resection, although this was not possible in all cases. Spontaneous breathing was preferred during surgery, and resection was halted if any disturbance occurred. Bipolar or monopolar coagulation was avoided, and smooth compression and irrigation were used for bleeding control. Neuromonitoring was employed during surgery for all patients. Results Among the 22 patients included in this study, 4 presented with long tract symptoms, 3 had hydrocephalus, 5 had papillary stasis, 4 had cerebellar findings, 3 had gait disturbances, 1 had respiratory disturbance, and 1 had dysphagia. Gross total resection was achieved in 10 patients, near-total resection in 4, and partial resection in 8. Conclusion Surgery is a key treatment approach for brainstem tumors. It enables histologic diagnosis, improves symptoms, eliminates mass effect, and reduces malignant and stem cells. While gross total resection is recommended for brainstem tumors, it is crucial to exercise caution and avoid insisting on it in all cases as many midbrain, medullary, and cervicomedullary tumors are focal, exophytic, and benign. Partial, subtotal, and near-total resections can provide long-term survival with favorable prognoses. Moreover, monitoring for deterioration in heart and respiratory rhythms is crucial during surgery for brainstem tumors. Furthermore, surgery should be performed with maximum exposure and minimal retraction. Gross total resection can be achieved if the tumor has created a space by displacing tissues and if an entry point is detected. However, infiltrative, invasive tumors that spread through the tractus are currently inoperable, although exophytic components.

Aim: Observational studies have suggested that the causal relationship between systemic lupus erythematosus (SLE) and the risk of cerebrovascular disorders (CVDs) remains uncertain. The objective of this study was to evaluate the potential genetic differences between SLE and CVDs patients.

Material and methods: This genetic association study conducted Mendelian randomization (MR) analyses on the derived exposures and outcomes from summary statistics of genome-wide association studies (GWAS). This study employed univariate MR (UVMR) analysis, multivariable MR (MVMR) analysis, and meta-analysis, using data from large genomic databases such as the UK Biobank, FinnGen, and OpenGWAS. These methods aim to overcome confounding factors by using genetic variants as instrumental variables to infer causal relationships.

Results: The UVMR analysis revealed a genetic causal relationship between SLE and ischemic stroke, with a positive correlation (odds ratio [OR] 1.000367; 95% confidence interval [CI] 1.000074-1.00066; P =0.014). No evidence of a genetic causal relationship was found between SLE and other types of CVDs, including cerebral aneurysm, intracerebral hemorrhage, subarachnoid hemorrhage, stroke, and transient ischemic attack. MVMR analysis, after adjusting for confounders such as smoking and type 2 diabetes, confirmed the robustness of the association between SLE and ischemic stroke. Furthermore, a meta-analysis of multiple MR outcomes was conducted to verify the stability of the results (OR, 1.00037; 95% CI, 1.00008-1.00067).

Conclusion: Our study enhances the understanding of the genetic basis between SLE and various CVDs, particularly suggesting a positive causal association between SLE and ischemic stroke, and we emphasize the need for further research.

Aim: To evaluate the diagnostic and prognostic significance of miRNA signatures by identifying differences in miRNA expression between ruptured and unruptured intracranial aneurysm (IA) cases, as well as to pinpoint miRNAs that correlate with clinical severity in patients with aneurysmal subarachnoid hemorrhage (aSAH).

Material and methods: Peripheral blood samples were collected from 50 IA patients (25 without rupture and 25 with rupture) and 25 healthy controls. In the ruptured group, analyses were performed on samples collected on Days 3 and 5 after SAH. The clinical severity and outcomes of the disease were assessed using Fisher grades, WFNS grades, Hunt-Hess grades, and the Modified Rankin Scale.

Results: We found that the expression levels of miR-21-5p and miR-15a were significantly altered in unruptured aneurysms (UA) patients compared to controls. The expression levels of 10 miRNAs were significantly decreased in ruptured aneurysms (RA) patients compared to controls. The ruptured group also exhibited an upregulation of 16 miRNAs relative to the unruptured group. Furthermore, we noted a significant increase in miR-24 expression in RA patients between Days 3 and 5, suggesting its potential role in the progression of aSAH. miR-9p-3p and miR-497 were found to be associated with aSAH severity. Moreover, the levels of miR-451a, miR-146a-5p, miR-502-5p, and miR-497 were significantly lower in patients with poor outcomes compared to those with favorable outcomes.

Conclusion: These findings suggest that specific miRNAs may serve as potential diagnostic and prognostic biomarkers for IA and subsequent SAH, particularly on Day 3 following aSAH.

Aim: In recent years, there have been extensive studies using diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) to reveal the relationship between brain or cervical intramedullary lesions and neural pathways. However, there is a lack of sufficient research investigating the relationship between cervical extramedullary tumors and the spinal cord.This study aims to evaluate the contribution of DTI and DTT in assessing the relationship between cervical extramedullary tumors and the spinal cord, particularly in terms of diagnostic accuracy, clinical outcome prediction, and treatment planning.

Material and methods: Fifteen patients diagnosed with cervical extramedullary tumours were included in this prospective study. All underwent conventional 3T MRI, DTI and DTT to assess microstructural changes and neural tract displacement. Fractional anisotropy (FA) values were analysed, and tractography findings were correlated with clinical presentation and outcome.

Results: FA values showed significant reductions in lesion areas compared to normal tissue and displaced spinal cord (DSC), indicating microstructural disruption. DTT showed deviations or deformations of neural tracts in all patients, which correlated with the severity of clinical symptoms. ROC analysis demonstrated the high diagnostic accuracy of FA in differentiating lesions from normal tissue (AUC=0.880) and DSC (AUC=0.840).

Conclusion: DTI and DTT offer critical insights into the microstructural changes and spatial dynamics of cervical extramedullary tumors, aiding in the differentiation of lesions from normal tissue and DSC. This study highlights their potential to enhance diagnostic accuracy, improve clinical outcome prediction, and increase precision in neurosurgical planning for better patient outcomes.

Aim: This study aims to evaluate the incidence, risk factors, and spinopelvic alignment parameters associated with distal junctional failure (DJF) following posterior thoracolumbar stabilization surgery. The focus is on understanding how lumbar lordosis (LL), pelvic incidence (PI), and PI-LL mismatch contribute to the development of DJF.

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 LL, 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: Contusional expansion (CE) is a complex and preventable secondary injury. However, current treatments for CE focus on reducing intracranial hypertension and are not preventive, largely because the molecular mechanisms involved remain poorly understood. This study aimed to provide insight into the molecular mechanism of CE by creating experimentally induced contusion cerebri (CC) in rats and investigating whether melatonin administration prevents CE.

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.

Back pain is a widespread and debilitating condition that not only significantly impairs quality of life but also contributes to global disability rates, often eroding patients' sense of autonomy and independence. The initial management of back pain generally follows a conservative approach, encompassing physical therapy, pharmacological interventions, and lifestyle modifications aimed at alleviating symptoms and restoring functionality. Spine surgery, while frequently beneficial in addressing underlying structural issues, is not without its inherent risks. Among the most challenging outcomes of spine surgery is the persistence or recurrence of pain, a condition commonly referred to as Failed Back Surgery Syndrome (FBSS). Managing FBSS effectively requires a comprehensive and meticulous approach. When conservative measures for FBSS fail to yield satisfactory results, and revision surgery is considered, the role of advanced imaging techniques becomes increasingly critical. Standard imaging modalities offer unique advantages and limitations, emphasizing the importance of a multimodal imaging approach to achieve a comprehensive and accurate evaluation of the patient's condition. In recent years, single-photon emission computed tomography combined with computed tomography (SPECT/CT) has gained recognition as a valuable tool in the postoperative assessment of spine surgery patients. SPECT/CT has demonstrated superior efficacy in detecting specific complications such as pseudoarthrosis, hardware failure, and screw loosening. By integrating metabolic activity data within the spine and surrounding bony structures with the three-dimensional reconstruction capabilities of CT, SPECT/CT enhances diagnostic accuracy and informs more precise treatment decisions. This review aims to synthesize the current body of literature on the application of SPECT/CT in the postoperative evaluation of spine surgery patients, while also providing a comparative overview of other imaging modalities within this context. Our objective is to underscore the pivotal role that advanced imaging techniques play in improving patient outcomes, reducing the incidence of FBSS, and shortening its duration.

Amyloidosis is a progressive disorder marked by the deposition of insoluble fibrillar proteins that aggregate in various tissues, leading to tissue damage. Localized amyloidosis, known as amyloidoma, is particularly rare in the central nervous system and may be mistaken for neoplastic lesions due to similar radiological features. Consequently, the general approach often involves total excision. However, it is important to consider that biopsy of amyloidomas, rather than total excision, may be sufficient 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 patients recovering without complications following treatment. (4).