Turkish neurosurgery最新文献

Aim: To evaluate the safety and efficacy of the hybrid operating room (HOR) approach in the management of severe traumatic brain injury (sTBI) using Xper-computed tomography (CT)-guided imaging and neurointerventional techniques.

Material and methods: A retrospective analysis was conducted on 154 patients with TBI treated surgically between February 2020 and December 2023. Among these, 26 patients with sTBI were managed in an HOR equipped with an Allura Xper FD 20® system. Intraoperative interventions included Xper-CT confirmation, real-time imaging-guided hematoma aspiration or catheter placement, and combined neurointerventional procedures. Clinical outcomes were assessed using the Glasgow Outcome Scale- Extended (GOS-E) at 6 months, and procedural morbidity and mortality rates were documented.

Results: The 26 patients with sTBI had a mean age of 45.3 ± 12.0 years, with 60.4% being male. Xper-CT was used in all cases (mean: 1.7 scans/patient) for confirmation and in 11 cases (42.3%) for real-time guidance, enabling precise interventions such as parenchymal hematoma aspiration (30.8%) and external ventricular drainage (11.5%). Vascular injuries were managed with N-butyl cyanoacrylate glue or polyvinyl alcohol particle embolization (15.4%) and endovascular coiling for pseudoaneurysms (11.5%), with intraoperative angiography performed in 7.7% of cases. No HOR-related complications or reoperations were noted. Favorable outcomes (GOS-E?4) were observed in 42.3% of patients at 6 months, whereas the 28-day mortality rate was 19.2%, primarily owing to initial trauma (n=3) and pneumonia or sepsis (n=2).

Conclusion: The HOR approach represents a significant advancement in the management of sTBI and potentially improves the overall quality of emergency neurosurgical care.

Aim: To evaluate the role of recent endovascular techniques as less invasive alternatives in the management of multiple intracranial aneurysms, particularly in the context of heterogeneous aneurysm morphology and anatomical complexity.

Material and methods: This retrospective analysis included 65 patients with a total of 151 MIAs that were treated using endovascular approaches. Morphological parameters, anatomical location, and clinical features were evaluated. Treatment strategies included primary coiling, stent-assisted coiling, Y/X-stent coiling, flow diversion (with or without coiling), use of Woven EndoBridge devices, and parent artery occlusion. Patient outcomes were assessed radiologically (Raymond?Roy Occlusion Classification) and clinically (Modified Rankin Scale, Glasgow Outcome Scale).

Results: Morphometric parameters significantly differed by aneurysm location. Flow diversion was preferred for wide-necked ınternal carotid artery aneurysms, while coiling was more commonly used for aneurysms at bifurcation sites. Complete occlusion (Class I) was achieved in 70.2% of the cases, while residual neck/sac (Classes II?IIIa) were observed in 29.8% of the cases. Incomplete occlusion was associated with higher aspect ratios and was more frequent in aneurysms in the anterior and posterior communicating arteries and at the middle cerebral artery bifurcation. The clinical outcomes were favorable, with median Modified Rankin Scale and Glasgow Outcome Scale scores of 0.5 and 5, respectively. The mortality rate was 12%, with a median follow-up of 8.5 months.

Conclusion: Endovascular therapy provides a safe and effective approach to treat MIAs. Aneurysm morphology, especially location and aspect ratio, significantly influences angiographic outcomes, supporting the need for individualized treatment plans.

Aim: To investigate the short- term results of dynamic/semi-rigid stabilization in patients with cervical spinal stenosis and compare them with patients for which decompression and pos-terior cervical fusion was performed.

Material and methods: 28 patients were included in this study. Group 1 was the semi-rigid group (four male, ten female), 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 regarding 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 pathologies 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 out-comes as posterior 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: To assess the prognostic utility of the albumin-to-gamma-glutamyltransferase ratio (AGR) in patients with high-grade glioma [World Health Organization (WHO) grade III and IV] and to 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 found to be 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.

Aim: To describe a series of 31 surgically managed cases in a single center.

Material and methods: We retrospectively collected data from 31 surgically managed cases that occurred between October 2014 and July 2019. We used the PubMed database to conduct a systematic literature search.

Results: Out of 31 patients, 24 (77.4%) were male and seven (22.6%) were female, with a male-to-female ratio of 3.42:1. The mean age of injury was 45.81 years (range: 25?67 years). In 20 (64.51%) cases, the mode of injury was a fall, followed by a road traffic accident (RTA) in nine (29.03%) cases. The average duration from trauma to admission in the hospital was 8.13 days (range: 0?63 days), and the average duration of hospital stay was 13.03 days (range: 2?36 days). The most commonly involved vertebral level was C5?C6, affecting 16 (51.6%) cases. In 22 (70.96%) cases, closed reduction was achieved, while in nine (29.03%) cases, the reduction was achieved by open reduction. Of the 31 cases, 22 (70.96%) were managed by the anterior approach only, whereas seven were managed by the combined approach.

Conclusion: Subaxial cervical spine subluxation with a unilateral locked facet is an unstable injury; it should be managed surgically. For single-level subluxation with a unilateral locked facet, fixation and fusion from the anterior approach alone are sufficient if the closed reduction is achieved. In case of failed closed reduction, fixation and fusion using the anterior approach alone are sufficient after completing an open reduction from the posterior approach.

Aim: To investigate whether atlantoaxial intra-articular fusion (AIF) can maintain sagittal balance stability in the cervical spine during follow-up.

Material and methods: The data of 39 patients with anterior atlantoaxial dislocation who underwent AIF and 21 patients who underwent structural bone grafting (SBG) fusion were retrospectively reviewed. Radiographic variables, including T1 slope (T1S), C1?C2 angle, C2?C7 angle, C2?C7 sagittal vertical axis (SVA), and lateral atlantoaxial joint space height (LAAJSH), were measured preoperatively, postoperatively, and at the last follow-up. Analyzing the differences in cervical spine curvature and sagittal balance during the preoperative, postoperative, and follow-up periods, as well as identifying the influencing factors.

Results: In the AIF Group, compared to the preoperative measurements, there was a statistically significant increase in both the C1?C2 angle (p < 0.001) and LAAJSH (p < 0.001) at the final follow-up, while a significant decrease was observed in the C2?C7 angle (p < 0.001). At the final follow-up, there was a decrease in LAAJSH compared to immediately post-surgery (p < 0.001), but there were no significant changes in the C1?C2 angle (p=0.366), C2?C7 angle (p=0.502), T1S (p=0.082) and C2?C7 SVA (p=0.209).

Conclusion: Posterior AIF technique can effectively reconstruct the alignment of the atlantoaxial complex and avoid secondary imbalance and loss of lordosis of the subaxial cervical spine.

Aim: To summarise atypical cases of hemifacial spasm (HFS) found during microvascular decompression (MVD), and to investigate its pathogenesis and range of exploration.

Material and methods: We retrospectively analysed cases of HFS performed in our department in recent years and summarised the intraoperative electrophysiological monitoring findings, vascular and nerve exploration, and postoperative symptoms. We then discussed the pathogenesis of and treatment for atypical HFS.

Results: In total, 85 cases of facial nerve MVD were performed in the past 3 years, of which 77 (90.6%) were responsible factors in the root exit zone (REZ) and eight (9.4%) in the non-REZ. For patients without vascular compression of the REZ, the compression factors outside the REZ were separated, and the arachnoid band around the facial nerve was released; subsequently, the amplitude of the abnormal muscle response of the facial nerve diminished or disappeared. Facial twitch symptoms disappeared or improved significantly after surgery. Most symptoms disappeared after 3 months of postoperative follow-up.

Conclusion: Factors responsible for non-REZ observed during MVD of the facial nerve are not rare. It is suggested that fulllength exploration should be performed during facial nerve MVD under electrophysiological monitoring.

Aim: To evaluate the prognostic value of serum endothelin-1 (ET-1), monocyte chemotactic protein-1 (MCP-1), and lactic acid (LA) levels in patients with ruptured intracranial aneurysm (IA) after interventional embolization.

Material and methods: Patients with ruptured IA were divided into mild, moderate, and severe groups according to Hunt-Hess grades, and the correlation between serum parameters and disease severity was analyzed. Multivariate logistic regression was employed to analyze the influence of serum ET-1, MCP-1, and LA levels on the prognosis of patients, and ROC curves were plotted to analyze the predictive value of these parameters.

Results: There were 29 cases in the mild group (grade ?), 49 cases in the moderate group (grade ?-?), and 25 cases in the severe group (grade ?-?). In the severe group, serum ET-1, MCP-1, and LA were elevated compared to the moderate and mild groups, with the moderate group showing higher levels than the mild group. Serum ET-1, MCP-1, and LA levels were positively correlated with the severity of IA (p < 0.05). The Hunt-Hess grade, Fisher grade, and serum ET-1, MCP-1, and LA levels in patients with poor prognosis were higher than those with good prognosis. Hunt-Hess grade ?-?, Fisher grade 3 to 4, ET-1 ? 41.78 pg/mL, MCP-1 ? 229.05 ng/L, and LA ? 7.13 mmol/L were risk factors affecting the prognosis of patients after interventional embolization. The AUC values of serum ET-1, MCP-1, and LA levels to evaluate the prognosis of patients were 0.772, 0.871, and 0.791, respectively.

Conclusion: Serum ET-1, MCP-1, and LA levels correlate with disease severity in patients with ruptured IA and have predictive values for the prognosis of patients after interventional embolization. They are risk factors for poor prognosis of patients after interventional embolization.

Subthalamic nucleus deep brain stimulation (STN-DBS) is a safe and effective therapy for Parkinson´s disease (PD) in selected patients. However, various side effects such as paraesthesia, diplopia, ataxia, worsened akinesia, emotional changes, dysarthria, and muscle contractions can occur due to the current spread to the adjacent structures during the STN-DBS programming sessions. Muscle contractions result from the corticospinal and corticobulbar side effects, which can manifest due to the current spread to the pyramidal tract during DBS programming. Here, we report a case of tongue-twisting movement as a unique corticobulbar side effect of the STN-DBS programming in a patient with PD.