Turkish neurosurgery最新文献

Aim: To investigate the feasibility of transfecting the TNF-related apoptosis-inducing ligand (TRAIL) gene into neural stem cells (NSCs) in vitro, and explore whether NSCs retain their proliferative and differentiated activities after transfection.

Material and methods: NSCs were obtained from fetal mouse brains, cultured in serum-free medium and identified by immunofluorescence staining. Lentivirus vector solution containing green fluorescent protein (GFP) gene was added to the NSCs based on the multiplicity of infection (MOI). The transfection efficiency of GFP was observed using a fluorescence microscope and detected by flow cytometry. NSCs were transfected with GFP-TRAIL fusion genes mediated by the optimized MOI lentivirus solution. The expression of TRAIL proteins in NSCs was detected by immunofluorescence and Western blot analysis. The differentiation of NSCs were induced and identified by immunofluorescence staining.

Results: The optimal MOI value of virus transfection was 10, resulting in a transfection rate was higher than 90%. GFP fluorescence could be observed at 24 hours after transfecting GFP-TRAIL genes into NSCs with an MOI of 10, and reached the maximum value at 72 hours. Immunofluorescence and Western-blot assays confirmed that GFP-TRAIL fusion proteins could be continuously expressed stably. Transfected NSCs could differentiate into neurons and glial cells without any statistically significant difference compared to the non-transfected group.

Conclusion: Neural stem cells retained their proliferative and differentiated potential after being transfected with the TRAIL gene while sustainably expressing TRAIL protein.

Neural tube defects (NTD), caused by a disturbance in the neurulation process, are easily diagnosed and treated in the early years of life. Although early repair of NTD is advocated, there is lacking information on its natural course. There are only 11 cases, including this one, reported in literature of a cervical meningocele diagnosed and treated in an adult. A 64-year-old male patient was aware of a skin lesion on his neck but had not consulted a physician until 3 years ago when he started experiencing neuropathic pain in his arms. Cervical MRI revealed a posterior arch fusion defect, a syrinx cavity between the C2-C6 levels with a tethering meningocele at the C6 level. He was operated on with the excision of the skin tag and connecting stalk. During prone positioning and neck flexion, intraoperative neuromonitorazion indicated a loss in MEP values; thus, flexion was reduced. Intradural adhesiolysis of the connecting bands around the spinal cord was performed, and dura was sutured. The patient recovered uneventfully, but he still had neuropathic pain in his left arm aggravated by straining. Histological analysis revealed meningothelial cells and psammoma bodies. Postoperative MRI revealed the untethering of the spinal cord with relative reduction in the syrinx cavity. NTD can be easily detected and treated early in life to prevent neurological deterioration, to decrease the rate of infection, and to improve cosmetic appearance. However, because they are mostly treated during childhood, their natural course in adulthood remains unknown. There are only a handful of case reports of cervical meningoceles in adults. Pathological analysis suggestive of a meningioma may also shed light on the theory of "cutaneous meningioma." In addition, the loss of MEP values in neck flexion should caution surgeons in avoiding hyperflexion, especially in cases of spinal cord tethering.

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 investigate the treatment approaches and follow-up data of patients with pineal region tumours at our institution.

Material and methods: A retrospective study was planned to evaluate patients who diagnosed with a pineal mass between 2019 and 2022 whether incidentally or symptomatically. All patients were evaluated regarding their radiological findings, clinical, labrotary and radiological outcomes of surgery if any performed, intraoperative and postoperative pathological diagnoses, and radiological and symptomatic follow-up results for at least one year.

Results: A total of 16 patients were grouped into 2; intervention and conservation groups, respectively. Nine out of 16 patients received intervention (surgery with or without ionising radiation therapy) and remained 7 followed up without intervention. Seven patients in the intervention group were found to have triventricular hydrocephalus, and one had tetraventricular hydrocephalus. Endoscopic approach was the preferred surgical intervention in all operated patients which was conventional endoscopic third ventriculostomy (ETV) via a right-sided frontal burr hole. Five patients required a simultaneous external ventricular drain. Neuronavigation was used in all the procedures.

Conclusion: Neuroendoscopic intervention is a relatively safe, effective, low-cost initial procedure with low morbidity rates and enables patients to return daily life rapidly. Neuroendoscopy is the best approach for simultaneously providing tissue sampling and diversion of cerebrospinal fluid via ETV or septostomy in hydrocephalic patients with tumours in the pineal region.

Aim: To examine the fiber-based anatomy of the medial pontine area (MPA), one of the most commonly used brainstem (BS) safe entry zones in neurosurgery.

Material and methods: According to the protocol of Klingler and Ludwig, six BSs were kept in 10% formalin solution for at least 2 months. After removing the arachnoid mater, pia mater, and vascular structures, the samples were frozen at -16°C for at least 2 weeks. White matter (WM) pathways of the BS were gradually examined using fiber dissections under a surgical microscope.

Results: Safe entry zones of the BS were defined and investigated, focusing on the ventral pontine region and pontomesencephalic junction. Because of the lack of fibers on the anterior surface of the pons, the MPA formed a safe surgical area. The MPA, strategically positioned between the descending corticospinal tracts and extending securely to the anterior limit of the medial lemniscus, serves as a protective pathway, creating a secure environment for accessing safe entry zones within the BS during surgery.

Conclusion: The position of the MPA has the potential to provide a combined surgical path with superiorly located BS entry zones, resulting in a larger surgical area. Entry to the BS via the MPA increases the accessible surface area in the ventral pons and can be combined with the other perioculomotor safe regions outlined. Our findings might lead to safer endoscopic endonasal transclival interventions for intrinsic pontine lesions.

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 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.