Turkish neurosurgery最新文献

Aim: To evaluate the effect of intensive care follow-up and treatment methods on the prognosis of 28 patients admitted to the pediatric intensive care unit (PICU) due to stroke.

Material and methods: The data of patients aged between 28 days and 18 years followed up between 2011 and 2021 were recorded retrospectively.

Results: Thirteen (48.1%) patients were diagnosed with hemorrhagic stroke (HS), 11 (40.7%) patients were diagnosed with acute ischemic stroke (AIS), and three (11.1%) patients were diagnosed with cerebral sinus vein thrombosis. One patient was followed up for non-ruptured arteriovenous malformation (AVM) and was excluded from the HS group. The HS group consisted of eight patients with ruptured AVMs and five patients with ruptured intracranial aneurysms. The patients had male predominance, and seizures and headache were the most common complaints on admission. The rate of admissions due to seizures was higher in the AIS group. In the HS group, there was more involvement of the right side of the brain. Middle cerebral artery (MCA) involvement was higher in the AIS group. The AIS group had longer PICU hospitalization days and mechanical ventilator days. While unfractionated heparin was preferred for the treatment in the AIS group, endovascular embolization was preferred in the HS group. Decompressive surgery was performed in five patients. The overall mortality rate was 7.1%.

Conclusion: Although cerebrovascular events are rare in the pediatric population, achieving low mortality and morbidity is possible with the correct diagnostic and treatment methods.

Aim: To examine the outcomes of microsurgery only versus combined microsurgery and embolization in treating cerebral arteriovenous malformations (AVM).

Material and methods: A total of 62 patients (34 male and 28 female) with Spetzler-Martin grade 3 (n=44) and grade 4 (n=18) AVMs were examined. Thirty-seven patients were treated with a combination of microsurgery + embolization, whereas 25 patients were treated with microsurgery alone. The clinical characteristics of the treatment groups were compared (ruptured/unruptured, eloquent/non-eloquent, modified Rankin scores, duration of surgery, preoperative and postoperative hemoglobin levels, and use of blood products).

Results: The number of patients with ruptured or eloquently localized AVMs was more in combination of microsurgery + embolization. On the other hand, the duration, preoperative versus postoperative hemoglobin levels, and usage of blood products did not differ between treatment groups.

Conclusion: The results of the study showed no superiority of the combined treatment in managing AVMs in parallel to recent meta-analyses. However, a patient-tailored approach is recommended while making the treatment decision for such challenging intracerebral AVM cases.

Aim: To assess the combined antitumor potential of theranekron (Trn) and cisplatin in neuroblastoma (NB), a pediatric tumor characterized by high prevalence and mortality rates. The investigation involved examining the interaction between theranekron (10-100 ?M) and cisplatin (40 ?M) within this cell line.

Material and methods: The cytotoxicity of Trn was evaluated using MTT assays, cell volume analyses, apoptosis assessments, and measurements of mitochondrial membrane potential. These evaluations were conducted over a 24-hour incubation period.

Results: The coadministration of 100 µM Trn with cisplatin exhibited a cytotoxic effect of approximately 60%. Furthermore, it led to a reduction of up to 38% in cell volume. Notably, SH-SY5Y cells demonstrated an early apoptosis rate of 34.4%, accompanied by an eightfold decrease in mitochondrial membrane potential compared to the control group.

Conclusion: Trn demonstrated synergism and significantly enhanced the efficacy of cisplatin (p < 0.001). Nevertheless, further in-depth investigations are necessary to elucidate the intricacies of these synergistic effects.

Aim: To evaluate the effect of osteoplastic pterional craniotomy on temporal hollowing and its sequelae.

Material and methods: A total of 97 patients who underwent pterional craniotomy for an aneurysm were analyzed retrospectively. Of these 97 patients, 63 underwent surgery via the conventional pterional approach and 34 underwent surgery via the osteoplastic pterional approach. The temporal muscle volume was calculated bilaterally on CT images obtained in the sixth postoperative month. The results obtained in the conventional and osteoplastic approaches were compared.

Results: Of the 97 included patients, 45 were female and 52 were male. The mean patient age was 50.37 years. In the conventional group, 31 were female and 32 were male. In the osteoplastic group, 14 were female and 20 were male. The temporal muscle volume difference between the operated and non-operated side was not statistically significant in the osteoplastic group. However, the volume was slightly lesser on the operated side than on the non-operated side in the conventional group.

Conclusion: The osteoplastic pterional approach is superior to the conventional approach in preserving the muscle volume and function. Patients who underwent osteoplastic craniotomy demonstrated higher levels of satisfaction with their facial appearance compared to those who underwent craniotomy using the conventional pterional approach.

Aim: To investigate the neuroprotective effect of shilajit extract in experimental head trauma.

Material and methods: Three groups of 33 Sprague Dawley Albino strain male rats were included in the study. Group 1 (n=11): trauma but not treated. Group 2 (n=11): trauma and treated with 0.5 mL / rat saline Group 3 (n=11): 150 mg / kg shilajit extract was administered intraperitoneally in the treatment of trauma. Following the head trauma, the indicated treatments were applied to the 2nd and 3rd groups at the first, twenty-four and forty-eighth hours. Brain tissues and blood samples were taken after the control animals were sacrificed at the 72nd hour in all groups after trauma. Sections prepared from cerebral cortex and ca1 region were examined with hematoxylin eosin and luxol fast blue staining. Total antioxidant capacity, total oxidant capacity and oxidative stress index were measured from blood samples taken after routine procedures.

Results: The number of red neurons and the severity of edema were significantly higher in both the cerebral cortex and the ca1 region in the group treated with trauma only and in the group administered saline after trauma compared to the group that received shilajit extract after trauma. The total antioxidant capacity increased significantly in blood samples taken only from the group treated with trauma and saline in post-trauma treatment compared to the group given post-traumatic shilajit extract, while shilajit extract given due to traumatic brain injury significantly decreased the total oxidant capacity and oxidative stress index values compared to the other groups.

Conclusion: Shilajit extract has been shown to have a neuroprotective effect in the treatment of acute traumatic brain injury. Our study showed that shilajit may be a useful option in the treatment of secondary brain injury, in humans.

Background: Microvascular patch graft angioplasty is one of the most important revascularization techniques in cerebrovascular neurosurgery. It is necessary for surgeons to develop the microvascular patch graft angioplasty technique in the laboratory before performing it in a real human body.

Objective: To provide a training model for microvascular patch graft angioplasty of the common carotid arteries (CCAs) in rats.

Methods: Using male Sprague-Dawley rats (n=20), an oval-shaped arterial patch 3 mm in length and 1.2 mm in width was prepared from a segment of left CCA, and a linear longitudinal arteriotomy 3 mm in length was made along the anterior aspect of the right CCA, then the arterial patch graft was anastomosed to the right CCA with 10-0 sutures in an interrupted fashion. Patency was assessed immediately and 30 minutes after the procedure.

Results: All microvascular patch graft angioplasties of the rat common carotid arteries were successful, and all the patency rates immediately after the operation and thirty minutes after the restoration of blood flow were 100%.

Conclusion: The training model for microvascular patch angioplasty with rat CCAs can serve as a training tool for mastering the procedure, and this technique could provide an alternative strategy for the surgical repair of microvascular aneurysms and microvascular vessel injuries.