Turkish neurosurgery最新文献

Aim: To determine the effectiveness of extraventricular drainage (EVD) combined with fibrinolytics in reducing morbidity and mortality rates associated with intraventricular cerebral hemorrhage (IVH).

Material and methods: A literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO registration number: CRD42022332152). Articles were selected from various sources, including PubMed, Trip Database, LILACS, Cochrane Library, and ScienceDirect. Clinical trials focusing on IVH treatment using EVD and/or fibrinolytics were considered. The Risk of Bias in Non-randomized Studies of Interventions (ROB 2) tool was employed for bias assessment. A fixed-effects regression model was used following heterogeneity analysis. Treatment effectiveness was evaluated based on mortality outcomes.

Results: A total of 531 patients from four studies were included. The use of fibrinolytics significantly decreased IVH mortality compared with a placebo. The odds ratio (OR) for recombinant tissue plasminogen activator (rtPA) or alteplase was 0.54 [0.36; 0.82]. For urokinase (UK), the OR was 0.21 [0.03; 1.54], rendering it statistically non-significant. The overall OR was 0.52 [0.35; 0.78], and the heterogeneity I2 was 0% (indicating low heterogeneity).

Conclusion: While EVD alone is a common approach for managing hydrocephalus, its effectiveness is limited by potential blockages and infections. Combining EVD with UK or rtPA demonstrated improved patient outcomes. rtPA stands out as a reliable and effective option, while limited data are available regarding UK's effectiveness in reducing IVH mortality.

Aim: To compare microsurgical clipping and endovascular therapy (EVT) for the management of shunt-dependent hydrocephalus (SDH) in patients with subarachnoid hemorrhage (SAH) and hydrocephalus.

Material and methods: This retrospective study was conducted from July 2018 to December 2022 and included 67 patients with SAH accompanied by acute hydrocephalus. Patients' demographic, clinical, and radiological data, such as age, sex, Glasgow Coma Scale scores, Hunt and Hess scale, Fischer grade, external ventricular drain (EVD) duration, complications, Ommaya reservoir placement, cerebrospinal fluid drainage, and outcomes, were obtained. Statistical analyses, including univariate analysis and stepwise logistic regression, revealed significant risk factors for shunt dependence.

Results: Of the 67 patients, 33 underwent microsurgical clipping and 34 received EVT. Spasmolysis reduced shunt dependency, whereas early EVD placement correlated with reduced shunt dependence (p=0.002). The Ommaya reservoir helped in the management of meningitis but was found to be associated with shunt dependency (p=0.04). Multiple logistic regression analysis revealed that perioperative infarct was a significant risk factor for shunt dependence (p=0.05). No significant difference in patient outcomes was observed between the two treatment groups. However, patients who received EVT had shorter intensive care unit and hospital stays.

Conclusion: This study shows that managing clinical vasospasm with spasmolysis may reduce shunt dependency. Overall, both microsurgical clipping and EVT offer similar long-term outcomes and efficacy in preventing shunt dependence, but the latter has the advantage of shorter hospital stay. These findings provide crucial insights for clinical decision-making and patient care in SDH after SAH.

Aim: To compare T1-weighted contrast-enhanced (T1+C) with fast imaging employing steady-state acquisition (FIESTA) magnetic resonance imaging (MRI) sequences to protect healthy brain tissue during meningioma treatment with Gamma-Knife radiosurgery (GKRS).

Material and methods: After reviewing the data of 54 patients with solitary meningioma who underwent GKRS between January 2020 and June 2022, demographic characteristics were noted, tumor volumes on T1+C and FIESTA MRI sequences were measured, and sequences were compared. The patients were then divided into two groups according to the presence of invasion to intracranial venous sinuses (groups 1 and 2, respectively). SPSS 11.5 software was used for data analysis, with the level of significance set at 0.05.

Results: While no significant age and tumor size differences were observed between groups 1 and 2, sinus invasion was significantly higher among males. Tumor volumes measured in both groups were significantly smaller on FIESTA sequences than on T1+C sequences.

Conclusion: The T1+C sequence has been the primary imaging method because of meningiomas' high contrast enhancement feature. However, the T1+C sequence during GKRS planning is an effective imaging method in treating meningiomas; FIESTA sequences can more precisely delineate the tumor border. In this study, we consider that using the FIESTA/CISS sequence MRI for planning meningioma therapy with Gamma-Knife can reduce target volume and prevent irradiation of healthy brain tissue.

Aim: To evaluate the effects of tramadol on inflammation by measuring NLRP1 and IL-1 beta (IL-1β) levels in an experimental neuropathic pain model.

Material and methods: Sprague-Dawley rats were divided into three groups: control, chronic constriction injury (CCI), and CCI + tramadol. Neuropathic pain was assessed using mechanical allodynia, thermal hyperalgesia, and cold allodynia. IL-1β and NLRP1 levels were evaluated using ELISA on sciatic nerve (SN), dorsal root ganglion (DRG), and serum either on day 3 or days 8 postsurgery.

Results: On day 3, paw withdrawal latency (PWL) was lower in the CCI and CCI + tramadol groups than the control group in both mechanical and cold allodynia tests. On day 8, the PWL in the CCI group was also lower than in the control group. In contrast, tramadol increased the PWL on day 8 compared to day 3 in the CCI group. During cold allodynia, PWL decreased in the CCI group, however, tramadol reversed this effect on days 3 and 8. Tramadol, therefore, ameliorated pain hypersensitivity in mechanical/cold allodynia tests. Serum IL-1β levels were higher in the CCI + tramadol and CCI groups than the control group, although serum IL-1β levels in the CCI and CCI + tramadol groups were comparable. Tramadol decreased the IL-1β and NLRP1 in DRG compared with the CCI group. A similar trend was observed in the SN samples.

Conclusion: Our experiments revealed an increase in IL-1β and NLRP-1 levels in a neuropathic pain model and found that tramadol had an anti-inflammatory effect on the IL-1β and NLRP1 inflammasomes.

Definitive diagnoses in neuro-oncology often require invasive procedures, such as surgical biopsies to obtain tissue for histopathologic and molecular interrogation. Patients with small lesions that may respond to nonsurgical treatments, such as chemoradiation, may nevertheless undergo surgery with potential risks to obtain diagnostic tissue. A means for noninvasively obtaining diagnostic information from brain tumors may improve patient care by limiting the need for surgery. Molecular evaluation of exosomes may provide such a means. Exosomes are small vesicles excreted from tumor cells that contain molecular information. Isolation of these vesicles from peripheral fluids, such as blood and urine, may provide diagnostic information for rendering a definitive diagnosis. Here, we review current clinical data for exosome-mediated brain tumor diagnostics.

Aim: To identify the patterns and types of neuorosurgical injuries sustained by victims of the double earthquakes affected ten cities with a population of 15 million in southern and central Türkiye.

Material and methods: In this descriptive observational study, we retrospectively analyzed the medical records of a university hospital located in one of the ten cities affected by the earthquake.

Results: A total of 1,612 patients with earthquake-related injuries were admitted during the study period, of which 139 (8.6%) had neurosurgical injuries. The mean age of the patients was 42.4 ± 21.1 years (median, 42 years), and 53.2% of them were female. Of the 139 patients with neurosurgical injuries, 41 (29.5%) had craniocerebral injuries, 95 (68.3%) had spinal injuries, and three (2.2%) had both craniocerebral and spinal injuries. A total of 31 surgeries were performed (22.3%) (five [3.6%] for craniocerebral injuries and 26 [18.7 %] for spinal injuries). Ninety-eight patients (70.5%) had concomitant systemic traumas. The overall mortality rate was 5.75%, with crush syndrome (n=4, 50%), being the leading cause of death, followed by neurosurgical pathologies (n=3, 37.5%) and pneumonia with septic shock (n=1, 12.5%).

Conclusion: Neurosurgical injury is an important cause of post-earthquake mortality and morbidity. To ensure efficient medical rescue and judicious resource allocation, it is essential to recognize the characteristics of earthquake-related neurosurgical injuries. This study provides valuable information regarding the incidence, characteristics, and outcomes of neurosurgical injuries in earthquake-affected patients. Our findings highlight the need for prompt diagnosis and management of such injuries, particularly in those with concomitant systemic trauma.

Aim: To evaluate the occurrence of proximal junctional kyphosis (PJK) as well as both the clinical and radiologic outcomes of patients who underwent surgery for Scheuermann?s Kyphosis (SK) using either exclusively pedicle screws or a combination of proximal hooks and pedicle screws constructs.

Material and methods: Surgically treated 37 patients with the diagnosis of SK were evaluated retrospectively. The patients were divided into two groups based on the type of instrumentation employed. The first group contained 22 patients with only pedicle screws (PP) while the second group consisted of 15 patients with mixed constructs that were proximal hooks and pedicle screws (HP) at the rest of the levels. The clinical and radiological data were compared in patients who were followed up for a minimum of 2 years.

Results: The average duration of follow-up for the PP group was approximately 94.7 ± 53.1 months, whereas the HP group had an average follow-up period of around 103 ± 64.4 months. After conducting the analyses, no statistically significant findings were identified in the measurements taken for the SRS-22 scores in preoperative, postoperative, and the most recent follow-up radiographs (p > 0.05). It is worth noting that among patients who exclusively utilized pedicle screws, both the proximal (p=0.045) and distal (p=0.030) junctional kyphosis angles experienced more pronounced increases compared to hybrid structures.

Conclusion: While no notable distinction was observed between the two groups, patients with pedicle screws fixation had a higher PJK angle. Conversely, the use of hooks at the upper end seems to be a preventive measure against the development of PJK.

Taste consists of sensation and perception. Specific neural structures transmit a stimulus from the taste buds to the gustatory cortex to generate taste sensation. Any disruption of this pathway, whether it affects sensation or perception, can result in taste disorders. Stereotactic procedures involving the thalamus may result in gustatory complications. A 41-year-old female patient who underwent stereotactic drainage of a thalamic cyst suffered transient ageusia. Subsequently, she developed metallic taste perception. When her stereotactic plan was re-evaluated, it was noted that the posteromedial ventral thalamus nucleus was in the path of the needle tract and the needle had passed through it. Follow-up was recommended and her symptoms completely resolved within 2 months following surgery. Modern imaging techniques allow for the visualization of neural structures related to the sense of taste. Additionally, care must be taken when planning stereotactic procedures for such lesions.

Vagal paragangliomas (VPs) are rare tumors arising from paraganglionic tissue within the vagal nerve's perineurium. Usually, benign vascular tumors, VPs tend to invade the surrounding structures. Herein, we report the case of a VP presenting as a neck mass, which was evaluated as a glomus caroticum tumor preoperatively. A 65-year-old female complaining of a left-sided neck mass and intermittent hoarseness was assessed and operated on for possible glomus caroticum tumor. During the tumor excision, the vagal nerve was also involved, and hence, sacrificed. Histopathological examination revealed an encapsulated tumor associated with a nerve and ganglion and immunohistochemical staining tested positive for succinate dehydrogenase, confirming the diagnosis of VP. Postoperative residual hoarseness was corrected by vocal rehabilitation. While evaluating a retropharyngeal prestyloid neck mass, a VP should always be considered. Surgical excision involving vagal scarification, followed by vocal rehabilitation may be the appropriate treatment strategy.

Aim: To determine whether there is a correlation between a deeply seated L5 vertebra in relation to the intercrest line (ICL) and the level of degeneration of lumbar discs.

Material and methods: The study included 152 patients who underwent surgery for lumbar disc herniation. After analyzing the radiographs, the patients were separated into two groups. Group 1 patients had an ICL that passed through the L4 corpus, and Group 2 patients had an ICL that passed through the L4-5 disc distance or the L5 vertebra. Group 1 patients were classified as having a deeply seated L5 vertebra, while Group 2 patients were classified as not having a deeply seated L5 vertebra.

Results: The study found that male patients had a significantly higher incidence of a deeply seated L5 vertebra compared to female patients (p=0.003). Patients who underwent surgery at the L4?5 level exhibited disc heights that were notably higher than those who underwent surgery at the L5-S1 level. In Group 1, 68% of the patients had surgery at the L4-5 level, compared to only 41.7% in Group 2 (p=0.009).

Conclusion: When investigating the effects of the position of the L5 vertebra in relation to the ICL at the L4-5 and L5-S1 disc levels, the study found that having a deeply seated L5 vertebra protected against L5-S1 disc herniation and that L4-5 disc herniation was more common in these patients. This is believed to be due to the L5?S1 segment being less mobile when the L5 vertebra is deeply seated.