Turkish neurosurgery最新文献

Aim: Successful deep brain stimulation (DBS) requires precise electrode placement. However, brain shift from loss of cerebrospinal fluid or pneumocephalus still affects aim accuracy. Multidetector computed tomography (MDCT) provides absolute spatial sensitivity, and intraoperative cone-beam computed tomography (iCBCT) has become increasingly used in DBS procedures. However, its accuracy is unclear. We examined iCBCT accuracy and the need for postoperative imaging to confirm electrode position and assess complications of DBS surgery.

Material and methods: Thirty-two movement disorder patients, and 69 targets were retrospectively reviewed. All patients had preoperative non-stereotactic 3.0 Tesla magnetic resonance imaging (MRI), preoperative stereotactic MDCT, post-implantation iCBCT, and postoperative conventional MDCT scans. Stereotactic coordinates of electrode tips were compared between postoperative MDCT and iCBCT. We calculated the absolute and Euclidian differences (ED) between iCBCT and postoperative MDCT coordinates for each electrode. To assess whether intraoperative brain shifting influenced electrode tip localisation, subdural pneumocephalus volume was measured in iCBCT images.

Results: The mean absolute (scalar) differences in x, y, and z coordinates were not significantly different from the absolute precision value of 0 (p 0.05). The mean ED between the iCBCT electrode tip and the postoperative MDCT electrode tip coordinates was 1mm (0.55±0.03 mm) and differed significantly from zero (p 0.0001). There was no correlation between pneumocephalus volume and electrode coordinate deviation.

Conclusion: iCBCT can eliminate the need for routine postoperative studies since it is a safe, effective, and rapid procedure that can be performed at any step of the surgery. It provides reliable and definitive confirmation of correct DBS electrode placement.

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Vagus nerve schwannoma is an infrequently occurring schwannoma, in which a distinct subtype exists wherein the tumor is confined to the cerebellomedullary cistern without invading the jugular foramen. This unique tumor is called purely intracranial vagal schwannoma. In this case report, we present a case of purely intracranial vagal schwannoma in its asymptomatic early phase, incidentally discovered during surgery performed on a patient with hemifacial spasm. Because of the small size of the tumor, we definitively recognized that it originated from the second rootlet on the caudal side. The tumor was totally resected uneventfully and a favorable prognosis was achieved. Furthermore, we conducted a comprehensive literature review to summarize the classification, origin, and surgical complications associated with this rare tumor type. Based on our literature review, we propose that: 1) the origin of tumor is related to the time of onset of symptoms, 2) nearly all purely intracranial vagal schwannomas can be entirely resected and favorable prognosis can be achieved, and 3) surgeons should be aware of potential cardiovascular complications during surgical procedures.

Aim: To examine the anatomy of the petrosphenoidal ligament (PSL), and its relationship with the abducens nerve (AN) in newborn cadavers.

Material and methods: Using 10 formalin-fixed newborn cadavers, 20 PSLs and ANs on both sides were examined. The structure of each PSL, its morphometric features, and its relationship with the AN were evaluated. For the morphometric measurements, photographs were taken in macro mode and then the ImageJ program was used.

Results: The PSL was usually shaped like a butterfly. The structures of all the ligaments were complete. The PSL was attached to the petrous apex posteriorly and to the clivus or posterior clinoid process (PCP) anteriorly. The mean PSL length was 6.58 ± 1.4 mm. The mean width of the ligament's attachment to the petrous apex was 3.12 ± 0.63 mm. The mean width of the ligament's attachment to the PCP or clivus was 3.12 ± 0.5 mm. The AN was located below the PSL in all the samples. It was usually situated in the 1/3 lateral part under the PSL (70%). The mean diameter of the AN, as located under the ligament, was 0.8 ± 0.12 mm.

Conclusion: The PSL serves as an important anatomical landmark in the petroclival region. In addition, AN is closely adjacent to many anatomical structures such as the trigeminal nerve and internal carotid artery. The increased knowledge obtained through this study on newborn cadavers concerning the anatomy of the PSL and its relationship with the AN will help increase the success of surgical procedures and reduce surgical complications.

Aim: To investigate the correlation between specific glioblastoma multiforme (GBM) molecular markers and their proximity to the subventricular zone (SVZ) to uncover potential prognostic indicators and therapeutic strategies.

Material and methods: The study retrospectively analyzed 171 patients who underwent surgery for supratentorial GBM from 2016 to 2022. GBMs were categorized into SVZ contact (SVZ + GBM) and SVZ noncontact (SVZ-GBM) groups. We analyzed molecular markers, such as IDH1, P53, ATRX, Ki67, GFAP, and Olig2.

Results: SVZ + GBM tumors were larger (12.2 cm3) than SVZ-GBM tumors (4.8 cm3; p < 0.001). Additionally, IDH1 mutation was negative in 100% of SVZ-GBM tumors; ATRX loss was more prevalent in SVZ + GBM tumors (34.3%) than in SVZ-GBM tumors (4.5%; p < 0.001). There was no correlation between SVZ contact and the p53 value (p=0.134). Furthermore, no difference was observed in the association of the Ki67 proliferation index and Olig2 positivity with SVZ contact (p=0.306, p=0.071, respectively). However, there was a correlation between IDH1 mutation and SVZ contact, with all IDH1-positive tumors showing SVZ contact (p=0.009).

Conclusion: This study revealed a correlation between SVZ contact in GBM and specific molecular markers, specifically IDH1 mutation, ATRX loss, and tumor size. SVZ contact could serve as criterion for categorizing GBMs, thus contributing to an improved understanding of the disease and potential therapeutic interventions.

Aim: To share the surgical outcomes of 31 patients who underwent endoscopic endonasal transsphenoidal surgery (EETS) at a single center.

Material and methods: This retrospective analysis of 31 craniopharyngioma cases (2013-2022) with a minimum 6-month follow-up included demographic data, preoperative findings, postoperative resection volumes, recurrence rates, pathological diagnoses, and complications.

Results: Herein, 34 EETS surgeries were performed on 31 patients (12 males, 19 females). The presenting symptoms included visual loss (58%), hypopituitarism (54.8%), and diabetes insipidus (25.8%). Gross total resection was achieved in 87% of the patients, with 64.5% total and 22.5% near-total resection. Total resection prevented recurrences, contrasting with 75% recurrence in the subtotal resection patients (p=0.000). The primary patients showed 73.1% total resection, while only 20% of the recurrent patients achieved it (p=0.049). When comparing the first 16 cases with the last 15 cases in terms of surgical experience, the rates of resection (p=0.040) and recurrence-free survival (p=0.020) in the last 15 cases were statistically significant. Patients with preoperative visual loss demonstrated 94.4% improvement or stability postoperatively. Postoperative complications included hypopituitarism (71.4%), permanent diabetes insipidus (60.8%), worsening vision (6.5%), cerebrospinal fluid leakage (9.7%), meningitis (6.5%), and a 3.2% perioperative mortality rate.

Conclusion: This study underscores the role of surgical resection in craniopharyngiomas, emphasizing the impact of surgical experience on recurrence-free survival. Primary surgery, with minimal complications and maximal resection, is crucial in managing recurrence challenges. Endoscopic endonasal transsphenoidal surgery, particularly in experienced centers, offers advantages such as panoramic vision and access to the third ventricle base, facilitating total and near-total resection and extending recurrence-free survival.

Aim: To retrospectively evaluate the cranial magnetic resonance imaging (MRI) features and determine the incidence of intracranial arachnoid cysts (ACs) based on sex, age, location, size, affected side, Galassi type, and their association with hydrocephalus, mega cisterna magna (MCM), bone erosion, and midline brain shift in 15,108 patients during outpatient headache evaluations.

Material and methods: Between 2012 and 2022, cranial MRI scans of 15,108 adult patients aged 20-70 years undergoing outpatient evaluations for headaches were retrospectively reviewed to analyze the features of ACs detected incidentally. Patients who had previously undergone a craniotomy or craniectomy were excluded from the study.

Results: The relationship between the location of AC and hydrocephalus did not show statistically significant differences between the supratentorial and infratentorial subgroups (p=0.557). The relationship between the location of AC and MCM showed statistically significant differences between the two groups (p=0.008). MCMs occur more commonly in supratentorial ACs than in infratentorial ACs.

Conclusion: The increased use of MRI in assessing patients with headaches has resulted in an increased detection of ACs. Although managing asymptomatic lesions typically involves periodic follow-ups, symptomatic lesions can sometimes require surgical treatment, such as AC fenestration, cyst aspiration, endoscopic shunt placement, or microneurosurgery.

Aim: To investigate cervical spinal tractography (CST) and diffusion tensor imaging findings in patients with intramedullary cervical spinal cord (CSC) tumors and to evaluate the association between qualitative diffusion tensor tractography (DTT) findings and neurological examination findings (NEF).

Material and methods: Neuroradiology case records were retrospectively evaluated to identify patients with intramedullary CSC tumors who underwent cervical spinal DTT. Conventional magnetic resonance imaging (MRI) and DTT were performed using a 3.0-T MRI system. Demographic data, CST and clinical findings, fractional anisotropy (FA), and apparent diffusion coefficient (ADC) were recorded. The sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively) were calculated.

Results: This study enrolled 31 patients (16 women and 15 men) with a mean age of 35.2 ± 15.6 years (range: 1-70 years). The mean FA and ADC were 0.34 ± 0.45 and 1.88 ± 0.89, respectively. Physical examination revealed hemihypesthesia (19.3%), hemiparesis (16.1%), and quadriparesis (3.2%). Completely normal neurological findings were observed in 61.3% of the patients. DTT revealed deviation (n=15), deformation (n=11), and interruption (n=5) of the fibers. No significant relationship was observed between NEF and DTT findings (p=0.127). The sensitivity, specificity, PPV, and NPV of DTT for CSC tracts were 100%, 0%, 38.7%, and 0%, respectively.

Conclusion: Although qualitative DTT of the CSC might be useful for planning and preservation of the fiber tracts during intramedullary tumor surgery, it did not exhibit significant association with clinical findings in this study. Qualitative DTT of CSC in patients with intramedullary tumors may not correlate well with NEF.

Aim: To determine the effects of different concentrations of Trolox on the cytotoxic, oxidant, antioxidant, and cytokine levels in the SH-SY5Y cell line.

Material and methods: SH-SY5Y cells were grown in an appropriate medium and under appropriate conditions. Trolox was added to the cell line at concentrations of 50, 100, 200, 400 and 800 μM and incubated for 24 and 48 hours. Subsequently, methyl thiazolyl tetrazolium (MTT) and proinflammatory cytokine level assays were performed, and the cytotoxicity of oxidative stress was assessed.

Results: Administration of 200 μM of Trolox reduced the cancer cell viability to 77.76%. Furthermore, Trolox exhibited a concentration-dependent effect on the SH-SY5Y cell line. Administration of 200 μM of Trolox also reduced the oxidant activity, increased the antioxidant capacity, and decreased the proinflammatory cytokine levels in neuroblastoma (NB) cells, which were consistent with the cytotoxicity test results.

Conclusion: The results of this experimental study demonstrated a Trolox concentration of 200 μM produces an anticancer effect on NB cell-line.