Turkish neurosurgery最新文献

Aim: To report our institutional experience of the one-stop treatment of Spetzler-Martin grade (SMG) III-V brain arteriovenous malformations (BAVMs) in a hybrid operating room.

Material and methods: Clinical data obtained from all the patients with SMG III-V BAVMs who underwent one-stop treatment in a hybrid operating room were analyzed. The measures included imaging characteristics, intraoperative blood loss, postoperative complications, residual lesions, and the presence of postoperative recurrence. Outcomes were assessed using the Glasgow outcome scale (GOS) score at six months post-surgery.

Results: A total of 16 patients were included in this study, 7 of whom underwent endovascular embolization followed by microsurgical resection and 9 underwent intraoperative cerebral angiography-assisted microsurgery. The average intraoperative blood loss was 473.3 mL. A remnant of BAVMs was found on the intraoperative cerebral angiography of one patient. Two patients underwent decompressive craniectomy due to postoperative cerebral swelling, including one patient with occipital lobe cerebral infarction and aphasia. No mortality was recorded. At the six-month postoperative follow-up visit, the GOS scores were 3 (n=4, 25.0%), 4 (n=4, 25.0%), and 5 (n=8, 50.0%). No recurrence was noted on brain digital subtraction angiography (DSA) in any of the postoperative reexaminations.

Conclusion: A hybrid operating room can fully combine the advantages of microsurgery and endovascular interventions, allowing for a high resection rate in the surgical treatment of SMG III-V BAVMs and a low rate of postoperative complications.

Aim: To analyze the clinical and angiographic outcomes of interventional embolization under transarterial balloon protection technique in patients with cavernous sinus dural arteriovenous fistulas.

Material and methods: In a single-center cohort of 30 patients undergoing cavernous sinus dural arteriovenous fistulas embolization under balloon protection. We collected their clinical symptoms, complications, mid-term follow-up angiographic results, and long-term clinical outcomes for the baseline characteristics.

Results: Thirty patients with 31 lesions were included in this study. Immediate applications of angiographies after embolization indicated that complete obliteration occurred in 29 lesions (93.5% of 31 lesions). Two cases with permanent trigeminal nerve palsy were treated by arterial approach. Onyx dispersed into the internal carotid artery in one process, and salvage stent implantation was performed to prevent parent artery occlusion.

Conclusion: Interventional embolization with intra-arterial balloon protection is effective and safe with rarely occurring complications.

Aim: To compare the postprocedural cerebral diffusion-weighted imaging (DWI) findings in cases of carotid stenosis (CS)-related carotid plaques in terms of plaque morphology, degree of stenosis, and the use of a distal protection filter. Moreover, we used DWI to assess the asymptomatic cerebral embolism rates during carotid artery stending (CAS) operations performed for noncalcified versus calcified carotid plaques.

Material and methods: Our study included 99 patients admitted to the Ankara City Hospital Stroke Center in 2022. All of our patients have been evaluated and scheduled for CAS as a result of a decision made by the council. Cases of stenosis of > 50% in symptomatic patients and > 70% in asymptomatic patients were included. The patients were grouped according to their Doppler ultrasonography results. All of the patients underwent DWI within the first 24 hours after the procedure, and then two groups of patients were compared.

Results: A statistically significant difference was found between the distributions of the presence of silent micro-infarcts on DWI in terms of plaque characteristics (p < 0.001). In the patients with normal DWI findings, the percentage of calcified plaques was 38.7%, while the percentages of hypoechoic plaques, plaques with low echogenicity, and ulcerated plaques were 91.3%, 85.7%, and 78.8%, respectively. The rates of calcified plaques and ulcerated plaques differed in the group of patients with silent microinfarcts. The rate of silent micro-infarcts was 61.3% in the patients with calcified plaques, 8.7% in those with hypoechoic plaques, 14.3% in those with low-echogenicity plaques, and 21.2% in those with ulcerated plaques.

Conclusion: The study found that carotid stents implanted in calcified and ulcerated plaques had a higher correlation with the presence of periprocedural asymptomatic ipsilateral DWI findings than those implanted in hypoechoic plaques and low-echogenicity plaques.

Aim: To compare the overall survival (OS), progression-free survival (PFS), and the impact of prognostic markers in unifocal and multifocal IDH wild-type glioblastomas (GBMs).

Material and methods: This retrospective single-institutional study involved 177 GBM patients diagnosed between 2015 and 2022. Patients with confirmed IDH wild-type GBM were selected to assess the impact of lesion focalities on prognosis. Surgical procedures included gross total resection (GTR), subtotal resection (STR) or biopsy. Radiation therapy (RT) employed the intensitymodulated (IM)RT technique, combined with concurrent temozolomide (TMZ) treatment. Survival analyses and prognostic factors were performed accordingly.

Results: We examined 101 IDH wild-type glioblastoma patients, of whom 78 had unifocal and 23 had multifocal tumors. The median patient age was 60 years, comprising 37% females and 63% males. Surgical approaches included GTR (13%), STR (53%), and biopsy (34%). Positive p53 expression was seen in 65 patients. All patients received TMZ with RT. Adjuvant therapy referral was arranged for 68 patients. Progression occurred in 49% (38 unifocal, 11 multifocal cases). PFS analysis showed no significant difference between unifocal and multifocal patients. OS analysis also showed no significant difference. Univariate analysis revealed PFS factors: focalization, p53 expression, hypofractionated RT. For OS, adjuvant TMZ usage was influential. Extent of resection impacted OS-STR had 3.47-fold higher risk than GTR.

Conclusion: This study sheds light on the management of multifocal glioblastoma, providing insights into treatment strategies and survival outcomes. Despite challenges, optimal management approaches are crucial for improving patient prognosis and quality of life.

Aim: To determine if previous histological grading systems were sufficient or unreliable with a limited repository of modern techniques.

Material and methods: The pathology reports of pediatric neurosurgery patients between 2019-2022 were accessed. Data on patients that needed unattainable further molecular investigation were extracted. Data were noted from electronic archives, including their sex, age, histologic grade, location, resection type, survival, and therapy.

Results: Out of 61 surgeries, 17 patients needed further investigation for a proper 2022 World Health Organization (WHO) diagnosis. Seven were deceased, and nine were alive. Two of 10 patients with low-grade gliomas and five of six patients with highgrade gliomas were deceased. Data on one foreign patient with high-grade glioma was inaccessible. The average survival was 9 months for the deceased.

Conclusion: Modern molecular techniques such as next-generation sequencing and methylation profiling are the state-ofthe- art methods, but it is hard for developing and underdeveloped countries to utilize such methods. The classification schemes, diagnostic key figures, and treatment modalities are developed using these techniques, but the less developed world is incapable of achieving these. We are trying to hybridize the modern and classic modalities, and the results of our study show that for overall survival, there is still not much difference. More economic and feasible techniques should be produced and summarized for the rest of the world.

Aim: To investigate the possible association between COVID-19 infection and intraparenchymal hemorrhage (IPH) by examining changes in the preoperative and postoperative periods, mortality, and the impact of COVID-19 on IPH survival times.

Material and methods: This cross-sectional retrospective analysis included 82 IPH cases operated on and treated between January 2021 and March 2023. Brain computed tomography/magnetic resonance imaging scans were used to confirm the diagnosis of IPH and provide evidence of neurological damage. The information was gathered using a predesigned form of hospital records. Participants were included if they had a positive COVID-19 result or displayed no symptoms, indicating a past infection.

Results: The study included 82 people, nine (11%) of who tested positive for COVID-19 and 73 (89%) tested negative. There was no difference in mortality rates between the two groups (p=0.651). The hematoma volume decreased from the preoperative (82.4 ± 42.4) to the postoperative (23.7 ± 44.8) measurement (p < 0.001). The midline shift value decreased from the preoperative (9.26 ± 4.71) to the postoperative (5.16 ± 5.06) assessment (p < 0.001). Patients without COVID-19 infection had a mean survival time of 31.5 days and a median survival time of 23 days, whereas patients with COVID-19 infection had a survival time of 25.7 days and a median survival time of 8 days.

Conclusion: Our findings show that hematoma volume and midline shift improve significantly after surgery, although GCS scores remain unaltered. Except for AST and ALT levels, there were no significant differences in mortality rates, demographic, clinical, and most laboratory results between COVID-19-positive and COVID-19-negative patients.

Aim: To investigate the impact of obesity on postoperative morbidity and mortality in patients who underwent anterior cervical discectomy and fusion (ACDF).

Material and methods: The American College of Surgeons' National Surgical Quality Improvement Project (NSQIP) files from 2006 to 2019 were queried for all patients who underwent an ACDF. Fisher exact tests were used in analyzing univariate differences in preoperative comorbidities and postoperative morbidity and mortality between patients with and without obesity (BMI ?30 kg/ m < sup > 2 < /sup > ). Results with a p value < 0.05 were considered statistically significant. Multivariable logistic regression models were used in determining the independent impact of obesity on ACDF postoperative morbidity and mortality. A p value < 0.017 was required for multivariate statistical significance.

Results: There were 96,882 patients who underwent an ACDF from 2006 to 2019 found. 53.77% had non-obese BMI. Patients had statistically significant differences in most perioperative comorbidities and postoperative outcomes on univariate analysis. On multivariate analysis, patients with obesity has decreased adjusted odds of wound infections (aOR=0.7208, CI 0.574-0.9075, p=0.0053), pulmonary events (aOR=0.7939, CI 0.6903-0.9129, p=0.0012), sepsis (aOR=0.5670, CI 0.4359-0.7374, p=2.32E-05), transfusion requirements (aOR=0.5396, CI 0.4498-0.6473, p=3.04E-11), return to operating room (aOR=0.7537, CI 0.6727-0.8447, p=1.17E-06), and length of stay > 10 days (aOR=0.7061, CI 0.6438-0.7744, p=1.49E-13).

Conclusion: Obesity is a protective factor toward ACDF postoperative complications. Obesity as a marker of patient selection criteria for ACDF procedures should not be used by spine surgeons.

Aim: To review the cases of craniosynostosis secondary to ventricular shunting procedure.

Material and methods: We retrospectively evaluated the medical records of all pediatric patients with hydrocephalus who were treated with ventriculoperitoneal shunt procedure between the years 2017 and 2021 at the Selcuk University, Ankara University, and Bursa Uludag University.

Results: Twenty-one patients were included in the study. The median age at the time of insertion of ventriculoperitoneal shunt for hydrocephalus was 8.1 (range, 1?22) months. Seven patients were shunted because of congenital hydrocephalus. The mean time to development of secondary synostosis was 8.8 (range, 1?36) months. Plagiocephaly was the most common type of secondary synostosis. While shunt revision was performed in 16 patients, cranial vault expansion surgery was performed in 5 patients.

Conclusion: Slit ventricle syndrome is a frequent condition at shunted patients, but there is no consensus on identifying patients who require treatment. Using programmable or high-pressure valves, performing cranial vault modeling are possible treatment modalities. Increased awareness of this condition in follow-up may allow early diagnosis and intervention and prevent it from evolving into more serious deformities.

Aim: To investigate the relationship between epidural contrast spread patterns, and the treatment success of cervical interlaminar epidural steroid injection (CIESI) for cervical radicular pain.

Material and methods: A total of 76 patients aged between 20 and 60 years who had neck and unilateral upper limb pain due to a single-level disc herniation at C5-C6 or C6-C7 were included. Severity of pain and disability were assessed with Numerical Rating Scale (NRS-11) and Neck Pain Disability Scale (NPDS) at baseline, three weeks, and three months after the treatment. Contrast dispersion prior to injection of the medication was graded in anteroposterior fluoroscopic view. Treatment success was defined as a ≥50% improvement at three months in the NRS-11 scores compared to baseline.

Results: A significant improvement in pain and disability scores was observed at three months compared to baseline (p < 0.001). Treatment success was observed in 57% of the patients. The multivariate binary logistic regression analysis revealed that high initial NPDS scores, severe foraminal and central stenosis, Grade 1 contrast spread pattern were negative predictors of response to CIESI.

Conclusion: Lateral contrast spread toward the dorsal root ganglion (DRG) and spinal nerve root of the target level was associated with more favorable clinical responses. Clinicians performing CIESIs should exert effort to administer the injectate around the DRG and spinal nerve root at the target level.

Aim: To examine the role and mechanism of colorectal tumor differential expression (CRNDE) in brain injury induced by ischemicreperfusion.

Material and methods: Sh-SY5Y cells were cultured, and oxygen and glucose deprivation/reperfusion (OGD/R) injury tests were performed. The effects on SH-SY5Y cells were evaluated by the Cell Counting Kit-8 (CCK-8) assay, qPCR, apoptosis analysis, western blot analysis, ELISA, a luciferase reporter assay, and an RNA pull-down assay.

Results: Knockdown of CRBDE ameliorated SH-SY5Y cell impairment induced by OGD/R. CRNDE, the target of mir-489-3p, was directly bound to FOXO3. Mir-489-3p knockdown partially reversed OGD/R-mediated impairment in CRBDE knockdown SH-SY5Y cells.

Conclusion: The results indicate that knockdown of lncRNA CRNDE ameliorates apoptosis and the inflammatory response in ischemia-reperfusion-induced brain injury through the mir-489-3p/FOXO3 axis. LncRNA CRNDE may represent a novel therapeutic target for brain injury.