Turkish neurosurgery最新文献

Aim: To evaluate the relationship between the most commonly used scoring systems, some disease parameters and prognosis in a patient group diagnosed with primary Central Nervous System Lymphoma (PCNSL).

Material and methods: Clinical information was collected from patients diagnosed with PCNSL between 2013 and 2024. In addition to previously defined and validated scoring systems (the International Extranodal Lymphoma Study Group (IELSG), the Nottingham/Barcelona (NB), and the Memorial Sloan-Kettering Cancer Center models (MSKCC), we have also evaluated some newly defined parameters. The predictive significance of all assessments for overall survival was investigated.

Results: A total of 37 patients received the diagnosis of PCNSL. We could not use the IELSG model due to missing data. The MSKCC groups were not associated with mortality. According to Kaplan-Meier test, age, Karnofsky performance status (KPS) scores and NB scores had a significant effect on survival (logrank test: p=0.002, < 0.001, and 0.006; respectively). The cut-off value for KPS score was determined as 85 points according to ROC analysis. The cut-off value for age was determined as 59 years. KPS < 85 and age ?60 years were determined as poor prognostic factors. This grouping with KPS and age variables was significant according to Kaplan-Meier survival analysis (logrank test: p=0.023). Mortality rates were significantly higher in patients fulfilling the KPS < 85 and age ?60 criteria (50.0 vs 88.9%, p=0.011, odds ratio: 8.0, CI95%: 1.4- 45.4).

Conclusion: This study was conducted in a single-center, under the conditions of our country?s health system. As in other classification recommendations, performance score and age were the most important survival determinants. We were able to classify the risk factors of the patients according to the NB scoring system which was a significant model in the prediction of survival.

Aim: To identify morphological differences in the cranial aperture (CA) of the optic canal (OC) in patients with Chiari malformation type 2 (CMT2) by comparing them with healthy individuals.

Material and methods: Computed tomography images were analyzed for 40 patients with CMT2 (16 females, 24 males; mean age, 10.05 ± 4.51 years; age range, 6?18 years) and 40 control subjects (21 females, 19 males; mean age, 10.03 ± 4.81 years; age range, 6?18 years). Measurements included the height (HCA), width (WCA), and surface area (ACA) of the CA, as well as the distances from the CA to the anterior border of the anterior cranial fossa (AB-CA), lateral border (LB-CA), and midsagittal line (MSLCA). Additionally, the angles of the OC were assessed in both the axial (APA) and sagittal planes (SPA).

Results: In the CMT2 group, mean values were as follows: HCA 3.64 ± 0.81 mm, WCA 3.08 ± 0.87 mm, ACA 7.58 ± 2.84 mm2, AB-CA 44.99 ± 7.69 mm, LB-CA 29.17 ± 5.03 mm, MSL-CA 7.07 ± 2.44 mm, APA 30.64° ± 6.03°, and SPA 24.31° ± 5.09°. In the control group, corresponding values were HCA 4.22 ± 0.60 mm, WCA 4.54 ± 1.04 mm, ACA 12.81 ± 3.80 mm2, AB-CA 52.73 ± 6.71 mm, LB-CA 35.86 ± 4.33 mm, MSL-CA 10.21 ± 2.21 mm, APA 35.96° ± 3.23°, and SPA 28.64° ± 4.34°. All measurements were significantly smaller in the CMT2 group compared to controls (p < 0.001).

Conclusion: Patients with CMT2 exhibit significantly reduced CA dimensions and angular measurements of the OC. These differences, particularly in depth and orientation, may be clinically relevant when planning surgical interventions such as OC decompression.

Aim: To observe the impact of the bilateral decompression with a unilateral approach technique, which is an effective and safe method in the surgical treatment of lumbar spinal stenosis (LSS) on the biomechanics of the spine in the early postoperative period and observe changes in sagittal balance parameters.

Material and methods: Forty-one patients who underwent bilateral lumbar decompression with a unilateral approach between March 2020 and March 2022 at our clinic were followed up prospectively for 1 year from the date of their operation, and their sagittal balance parameters were measured by performing whole-body radiography. The measurements were analyzed and recorded with Surgimap® (Nemaris, Inc. product, USA). Patients were divided into 3 groups ( < 50 mm, ?50 mm- < 100 mm, ?100 mm) according to their Sagittal Vertical Axis (SVA) values in preoperative measurements. The groups? clinical parameters and sagittal balance parameters were compared as preoperative and postoperative.

Results: Significant improvements were detected in the sagittal balance parameters of patients who underwent bilateral decompression with a unilateral approach in the LSS. SVA values decreased significantly from 64.8 mm preoperatively to 48.6 mm. We observed a significant increase in the lumbar lordosis angle from 41.7? to 45.9?. Functional improvements were observed with clinical pain control and an increase in walking distance in these patients. Furthermore, improvements were also observed in compensatory mechanisms along with improvements observed in sagittal alignment. Pelvic tilt and knee flexion angles decreased.

Conclusion: Bilateral decompression surgery with a unilateral approach, which is a minimally invasive approach in patients with lumbar degenerative stenosis, is an effective method that causes improvements in sagittal balance parameters and compensation mechanisms in these patients and ensures clinical improvement in these patients.

Aim: To examine the genetic results of patients diagnosed with pituitary neuroendocrine tumors (PitNETs) with respect to clinical, radiological, and pathological findings.

Material and methods: A total of 53 patients (30 men and 23 women) diagnosed with PitNETs were included in the study. The clinical findings, family history, imaging, and pathology results were recorded. The DNA was isolated from the peripheral blood. A customized panel test with the highest number of genes (28 genes associated with PitNET) found in the literature was used. Sequencing was conducted using the next-generation sequencing method, and the variants were analyzed according to current guidelines.

Results: A total of 22 variants were identified in 20 patients, two of which were determined to be pathogenic. Pathogenic variants were detected in AIP (c.468+1G > A) and MEN1 (c.1102_1104del) genes, which showed the most common pathogenic variant. Variants of unknown clinical significance were most frequently detected in the MSH6, RET, and CDH23 genes.

Conclusion: Although the number of studies that conducted multigene testing in patients with PitNETs is limited, all studies, including ours, have shown that the patient?s age at diagnosis and family history are the most important determinants of germline variant detection.

Aim: To report a series of pediatric intracranial meningiomas operated in a single institution, and to compare their features with the literature.

Material and methods: Using our hospital?s automation system, patients under the age of 18 who had been operated in the last 11 years were identified. Data from these patients were collected and compared with the literature.

Results: The mean age was 7.9 years old. Of the 10 patients, 8 (80%) were males, 2 were females (20%). The most common symptoms were cranial nerve palsies. When all MR and CT images were evaluated, peritumoral oedema was observed in 6 of the patients (60%), dural tail in 7 patients (70%), bone destruction in 3 patients (30%), and intratumoral calcification in 2 patients (20%). Histopathological diagnosis was made according to the World Health Organisation classification (2021) into grades 1, 2, and 3. Three patients (30%) had a typical meningioma (grade 1), and 7 patients (70%) had an atypical type (grade 2). Recurrence occurred in one of four patients with residual tumours.

Conclusion: Subtle and careful surgical approaches are the main treatment option and postoperative prognosis for pediatric meningiomas. Contrary to previous studies, the association of meningiomas with radiation exposure and NF was not common in our series. Further research is needed to understand the reasons for the differences between the pathophysiology of pediatric meningiomas and the adult form to ensure successful treatment.

Aim: To investigate the incidence of transverse carpal muscle (TCM) occurrence around carpal tunnel which may lead to carpal tunnel syndrome (CTS), and cause disorientation of surgeons during the surgery.

Material and methods: We reviewed patients in our department between January 2007 and March 2021 to identify those who underwent surgical treatment for CTS. A total of 62 carpal tunnel release surgeries were investigated, and the frequency of TCM occurrence was evaluated.

Results: There were 3 (4.8%) accessory TCM overlying transverse carpal ligament (TCL). All variations occurred in the left hand of the patients. Of the three cases, two were female and one was male.

Conclusion: There is currently insufficient evidence in the literature to suggest that TCM is causing CTS. To further investigate the origin of these muscles, cadaveric dissections should be performed. Even if this variation isn?t causing CTS, especially during minimal invasive surgeries, this variation should be kept in mind to not lose orientation.

Trigeminal schwannomas are rare lesions centered on the trigeminal ganglion at Meckel?s cave. The complexity and morbidity of surgery for these lesions have allowed stereotactic radiosurgery (SRS) to emerge as a safe and viable option for treatment. Various other lesions at this location must alert one to consider an alternative diagnosis before upfront SRS without histopathological correlation. We present three patients with trigeminal neuropathy with imaging suggesting trigeminal schwannoma. Primary clinicians recommended primary radiosurgery to these patients based on radiological diagnosis. Upon further evaluation and clinical suspicion, we established alternate diagnoses of non-Hodgkin's lymphoma, lepromatous trigeminal nerve involvement, and Aspergillosis involving the Meckel's cave in three cases. Each patient received appropriate treatment instead of SRS. SRS is one of the treatment options for trigeminal schwannomas. No neurosurgical ailment should be treated on its face value with primary SRS, but it must be carefully evaluated on a clinicoradiological profile. Upfront, primary SRS may be counterproductive or detrimental for inflammatory or infectious pathologies, attracting complications.

Aim: To explore the risk factors associated with the occurrence of lower extremity deep vein thrombosis (DVT) after craniotomy in patients with primary brain tumors, and to develop a predictive model using machine learning.

Material and methods: A prospective cohort study was conducted on 140 patients with primary brain tumors who underwent neurosurgical treatment at our hospital between March 2021 and September 2022. A logistic regression analysis was performed to identify independent risk factors associated with postoperative DVT. Additionally, multiple machine learning models were developed and evaluated to determine their predictive performance.

Results: The incidence of lower extremity DVT after craniotomy was 27.9%. Logistic regression identified age [OR=1.07, 95% CI (1.03-1.11)], GCS score [OR=0.88, 95% CI (0.78-0.98)], D-dimer level [OR=1.08, 95% CI (1.02-1.15)], and mechanical ventilation (≥48 hours) [OR=3.83, 95% CI (1.21-12.15)] as independent risk factors (P < 0.05). The Gradient Boosting Machine (GBM) had the highest prediction accuracy among the assessed machine learning models, achieving an area under the curve (AUC) of 0.850, with a sensitivity of 56.44% and a specificity of 90.09%.

Conclusion: Age, D-dimer, and mechanical ventilation (≥48 hours) are independent risk factors for the development of lower extremity DVT after craniotomy in patients with primary brain tumors. The GCS score serves as a potential protective risk factor. The GBM model, with its high AUC and specificity, offers a promising tool for early identification of high-risk patients, potentially informing clinical decision-making and targeted interventions.

Aim: To identify novel therapeutic strategies to improve the outcomes of neonatal hydrocephalus.

Material and methods: The treatment strategies for cases of neonatal hydrocephalus in our hospital between February 1, 2015, and February 1, 2024 reviewed and analyzed, with the aim of identifying valuable factors to assist in treating future patients with critical neonatal hydrocephalus. We further conducted literature searches and summarized the relevant treatment strategies.

Results: A total of 64 neonates were included. The causes of hydrocephalus by case number were as follows: 59.1% due to cerebral hemorrhage, 24.0% due to intracranial infection, and 16.9% due to other causes. Additionally, 32.8% of patients had ultra-low birth weight (ULBW), 14.1% had very low birth weight (VLBW), and 53.1% had low birth weight (LBW). Preterm babies comprised 84.3% of all patients, whereas term babies comprised only 15.7%. Additionally, all treatments for patients involved surgery, with 3.06% undergoing endoscopic third ventriculostomy (ETV), 29.59% undergoing ventriculoperitoneal shunt (VPS), 32.65% undergoing extra-ventricular drainage (EVD), 1.53% undergoing ventriculoatrial shunt (VAS), and 20.41% undergoing Ommaya reservoir. Based on the collected information, we propose a novel two-step surgical treatment process for intensive neonatal hydrocephalus. In the first step, the patient?s physical status (weight and corrected gestational age) is improved and intracranial infection or bleeding are controlled. In the second step, a permanent shunt is placed once the patient meets the surgical criteria.

Conclusion: Based on our experience, we proposed a two-step treatment strategy for the surgical management of critical neonatal hydrocephalus. Moreover, we clarified the detailed criteria for each step of the treatment plan to promote a higher success rate in saving children?s lives. The prognosis of critical neonatal hydrocephalus can be favorable if appropriately treated.

Aim: To investigate the clinical effect of neuroendoscopic surgery on 15 patients with hypertensive brainstem hemorrhage (HBSH).

Material and methods: A retrospective analysis was conducted on the clinical data collected from 15 patients with HBSH and treated with neuroendoscopy between January 2021 and March 2023. Prior to surgery, head computed tomography (CT) data were imported into 3D-slicer software to reconstruct the hematoma in three dimensions, allowing for the calculation of hematoma volume. During surgery, neuroendoscopy was used to clear the hematoma, after which the hematoma clearance rate, along with 30-day and 90-day mortality rates, was calculated. Three months after surgery, the Glasgow Outcome Scale (GOS) was used to evaluate patient prognosis, calculate the good recovery rate, and assessed surgical efficacy.

Results: Re-examination of head CT images within 24 hours post-surgery revealed a hematoma clearance rate of > 90% in 11 cases and over 80?90% in four cases, with a mean hematoma clearance rate of 90.52±3.85%. There were no complications associated with postoperative rebleeding, intracranial infection, or the leakage of cerebrospinal fluid. Mortality rates on days 30 and 90 post-surgery were 26.7% (4/15) and 40% (6/15), respectively. After a 3-month follow-up period, GOS prognostic scoring revealed that one case had recovered well and could live a normal life, two cases had mild disability, and two cases had severe disability. Four patients survived in a vegetative state while six patients died; the good prognostic rate was 20% (3/15).

Conclusion: Neuroendoscopic technology is safe and effective for the treatment of HBSH. This method has a high hematoma clearance rate and a good clinical treatment effect with few postoperative complications.