Turkish neurosurgery最新文献

Aim: To investigate the relationship between tumor volume and serum microsomal prostaglandin E2 (mPGE2) levels in patients with astrocytic tumors.

Material and methods: The study included patients with astrocytic tumors who were treated at our clinic between August 2015 and December 2016. Preoperative and postoperative contrast-enhanced cranial magnetic resonance imaging (MRI) scans were performed (within the first 24 h), and preoperative and postoperative residual tumor volumes were calculated. Microsomal prostaglandin E2 (mPGE2) levels were measured and compared in the serum samples of the patients before surgery, on the first day after surgery, and at 1 week after the surgery.

Results: The study included 20 patients, 13 of whom were males and 7 were females, with a mean age of 57.20 ± 14.66 yr. The mean postoperative tumor volume was 9,180.69 mm3 (range, 0.00-41,961.60), which was significantly lower than the preoperative mean tumor volume of 37,323.84 mm3 (range, 4,457.40-108,247.20; z = -3.920, p < 0.001). On the first postoperative day, the mean mPGE2 level was 1,776.50 pg/ml (range, 771-5,010), which was similar to the preoperative mean mPGE2 level of 1,769.20 pg/ml (range, 681-3,480). On the seventh postoperative day, the mean mPGE2 level was 955.50 pg/ml (range, 31-2,130), which was significantly lower than the preoperative and postoperative first-day mean mPGE2 levels (p < 0.001). No correlation was found between preoperative and postoperative tumor volumes and mPGE2 levels.

Conclusion: Compared with preoperative mPGE2 levels, mPGE2 levels decreased significantly on the seventh postoperative day. However, no correlation was observed between the tumor volume removed and decrease in mPGE2 levels.

Aim: To assess the effectiveness and safety of Virtual Reality (VR) simulations for education of posterior spinal instrumentation.

Material and methods: Participants were instructed to apply Cervical-Thoracic-Lumbar and Sacral posterior instrumentation techniques using the VR. Each participant underwent a qualitative assessment of the use of the VR. Patient-specific computed tomography (CT) studies were obtained to build a whole spinal model. Bone segmentation was performed upon the CT images. The participants can easily interact with the spinal model and evaluates the outcome from all the angles.

Results: A total of 63 participants who used VR stimulation as a primary application during the 4-day course were included in this study. The majority of our participants agreed with the benefit of the VR spinal instrumentation module, stating that it was useful for learning the 3D anatomy of the spinal region. Overall, according to the questionnaire and evaluations, the participants stated that this application was most beneficial in the education and preoperative planning.

Conclusion: VR-based surgical training is a promising solution for surgical education, particularly for junior residents, for improving the understanding of spinal instrumentation. In addition, modelling of patient-specific CT scans on VR provides a unique opportunity for improving pre-operative planning and preventing surgical complications.

Aim: To determine the effectiveness of extraventricular drainage (EVD) combined with fibrinolytics in reducing morbidity and mortality rates associated with intraventricular cerebral hemorrhage (IVH).

Material and methods: A literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO registration number: CRD42022332152). Articles were selected from various sources, including PubMed, Trip Database, LILACS, Cochrane Library, and ScienceDirect. Clinical trials focusing on IVH treatment using EVD and/or fibrinolytics were considered. The Risk of Bias in Non-randomized Studies of Interventions (ROB 2) tool was employed for bias assessment. A fixed-effects regression model was used following heterogeneity analysis. Treatment effectiveness was evaluated based on mortality outcomes.

Results: A total of 531 patients from four studies were included. The use of fibrinolytics significantly decreased IVH mortality compared with a placebo. The odds ratio (OR) for recombinant tissue plasminogen activator (rtPA) or alteplase was 0.54 [0.36; 0.82]. For urokinase (UK), the OR was 0.21 [0.03; 1.54], rendering it statistically non-significant. The overall OR was 0.52 [0.35; 0.78], and the heterogeneity I2 was 0% (indicating low heterogeneity).

Conclusion: While EVD alone is a common approach for managing hydrocephalus, its effectiveness is limited by potential blockages and infections. Combining EVD with UK or rtPA demonstrated improved patient outcomes. rtPA stands out as a reliable and effective option, while limited data are available regarding UK's effectiveness in reducing IVH mortality.

Aim: To compare microsurgical clipping and endovascular therapy (EVT) for the management of shunt-dependent hydrocephalus (SDH) in patients with subarachnoid hemorrhage (SAH) and hydrocephalus.

Material and methods: This retrospective study was conducted from July 2018 to December 2022 and included 67 patients with SAH accompanied by acute hydrocephalus. Patients' demographic, clinical, and radiological data, such as age, sex, Glasgow Coma Scale scores, Hunt and Hess scale, Fischer grade, external ventricular drain (EVD) duration, complications, Ommaya reservoir placement, cerebrospinal fluid drainage, and outcomes, were obtained. Statistical analyses, including univariate analysis and stepwise logistic regression, revealed significant risk factors for shunt dependence.

Results: Of the 67 patients, 33 underwent microsurgical clipping and 34 received EVT. Spasmolysis reduced shunt dependency, whereas early EVD placement correlated with reduced shunt dependence (p=0.002). The Ommaya reservoir helped in the management of meningitis but was found to be associated with shunt dependency (p=0.04). Multiple logistic regression analysis revealed that perioperative infarct was a significant risk factor for shunt dependence (p=0.05). No significant difference in patient outcomes was observed between the two treatment groups. However, patients who received EVT had shorter intensive care unit and hospital stays.

Conclusion: This study shows that managing clinical vasospasm with spasmolysis may reduce shunt dependency. Overall, both microsurgical clipping and EVT offer similar long-term outcomes and efficacy in preventing shunt dependence, but the latter has the advantage of shorter hospital stay. These findings provide crucial insights for clinical decision-making and patient care in SDH after SAH.

Aim: To investigate the morphometric and morphological development of the medial surface of the cerebrum in 40 fetal cadavers without external anomalies and pathologies between the gestational ages of 22 and 40 weeks.

Material and methods: In this study, we measured the height and width of the cerebral hemisphere, cingulate sulcus, marginal sulcus, sulcus of the corpus callosum, calcarine sulcus, parieto-occipital sulcus, and central sulcus in each hemisphere. We examined these measures between genders and sides and assessed how these parameters developed over the course of gestational age (measured in months). Additionally, we aimed to determine the age at which each sulcus started to be visible.

Results: The dimensions of the parameters showed a significant increase with gestational age. When comparing these parameters between the right and left hemispheres as well as genders, no statistically significant difference was found. Regarding the classification of the marginal sulcus, Type I accounted for 33% and Type II accounted for 32% of the cases. As for the classification of the parieto-occipital sulcus and calcarine sulcus, Type I was the most common with 47%, followed by Type II with 23%.

Conclusion: In our study, we believe that valuable parameters can be obtained to understand the morphometric development of sulcus structures in the medial surface of the cerebrum. The contribution of such studies to the knowledge of anatomy and neurosurgery will be significant. Knowledge of morphological differences in the cortex cerebri may also play a role in detecting certain neurological diseases (such as lissencephaly and Walker-Warburg syndrome) and explaining their neuropathology.

Aim: To examine the morphological properties of the cranial aperture of the optic canal (CAOC) in patients with a Chiari type-I malformation (CIM).

Material and methods: Radiological images of 40 patients with CIM (24 females/16 males, mean age: 20.75 ± 14.98 years) and 40 normal individuals (24 females/16 males, mean age: 23.13 ± 18.89 years) were included in the study to assess the anatomical features of CAOC.

Results: The CAOC width (p=0.137), CAOC height (p=0.243), distance between the CAOC and the midsagittal line (p=0.982), and angle of the optic canal in the sagittal plane (Ang-in-SP) (p=0.598) were similar in patients with CIM and in the controls. The distances between the CAOC and the anterior (Dis-to-AB) and lateral (Dis-to-LB) boundaries of the anterior skull base were smaller in patients with CIM than in the controls (p < 0.01). However, the angle of the optic canal in the axial plane (Ang-in-AP) was greater in patients with CIM than in the controls. Four different aperture shapes were identified in the CIM group (teardrop, n=42 [52.40%]; triangular, n=17 [21.30%]; oval, n=9 [11.30%]; and round, n=12 [15%]) and in the control group (teardrop, n=36 [45%]; triangular, n=14 [17.50%]; oval, n=10 [12.50%]; and round, n=20 [25%]).

Conclusion: A greater Ang-in-AP and shorter Dis-to-LB and Dis-to-AB were found in patients with CIM than in the healthy controls. The distance measurements demonstrate that patients with CIM have a shorter and narrower anterior fossa than normal individuals.

Aim: To investigate changes in nitric oxide (NO) levels, oxidative stress, and dynamic thiol/disulphide homeostasis in the serum and cerebrospinal fluid (CSF) of patients with aneurysmal subarachnoid hemorrhages (aSAH).

Material and methods: This prospective study included a total of 40 consecutive patients suffering from aSAH, who were operated on within the first 48 hours from onset of symptoms; CSF and blood samples were collected from these patients during their operations. To create a control group, blood samples and cerebrospinal fluid were taken from patients (n=40) without neurologic disorders who had undergone lumbar puncture for spinal anesthesia.

Results: We observed that the serum total antioxidant status had decreased markedly (p=0.0143) but that no change was evident in the oxidative stress index and total oxidant status in aSAH patients when compared to the controls. While total thiol (p=0.0014) and native thiol (p < 0.0001) levels had decreased in the aSAH patients, disulphide levels (p < 0.0001) had increased significantly. Although the native thiol/total thiol ratio declined (p < 0.0001), the dynamic disulphide/total thiol ratio (p < 0.0001) and dynamic disulphide/native thiol ratio (p < 0.0001) increased markedly in serum samples from the patient group. Patient serum NO levels were also significantly elevated (p < 0.0001). There were no marked changes in CSF for all measured parameters (p > 0.05).

Conclusion: This study demonstrated that serum NO levels and oxidative stress parameters increased markedly in the patients. These results may help to understand the underlying mechanisms behind early tissue damage due to aSAH and to monitor disease progression and improve the early detection of disease severity.

Aim: To investigate the surgical outcomes in patients with nonfunctional pituitary adenomas (NFPAs) exhibiting visual field defects (VFDs) in order to ascertain the impact of the volume of adenoma excised during surgery on recurrence rates and improvements in VFDs.

Material and methods: From a cohort of 150 individuals diagnosed with NFPAs and exhibiting suprasellar extensions accompanied by VFDs, we selected 114 patients who fulfilled the inclusion criteria for further analysis after a comprehensive retrospective review. All selected patients underwent pituitary magnetic resonance imaging (MRI) examinations, and volumetric measurements were conducted on T1 contrast sequences using the Syngo.via software. Measurements were derived from MRI scans taken 24 h preoperatively, 24 h postoperatively, at 3 months, and at the end of the first year postsurgery. Volumetric values were compared between patients who underwent subsequent surgeries due to recurrence and those who did not. Similarly, the variables were evaluated in patients experiencing an improvement in VFD, those whose VFD remained stable, and those experiencing a deterioration in VFD.

Results: The recurrence rate was 19.3%. Among patients who underwent a second surgery due to recurrence, the presurgical adenoma volume, the adenoma volume removed based on the 24-h postoperative MRI, and the volumes recorded in the 3-month and 1-year postoperative imaging were significantly greater than those in patients who did not require a second surgery. Remarkable improvements were identified in 84.2% of patients with VFD complaints and 62.5% of those with visual acuity complaints.

Conclusion: Adenoma volume measurements exerted a significant impact on recovery from VFDs and the need for a second surgery. Although the choice of surgical methodology does not definitively affect outcomes, an in-depth evaluation of variations in adenoma volume can provide valuable prognostic insights.

Aim: To assess the performance metrics of perfusion and permeability magnetic resonance imaging (MRI) parameters with optimal cut-offs in differentiating isocitrate dehydrogenase (IDH) genotype and tumor grade in patients with grade 2-4 gliomas.

Material and methods: This retrospective study included 36 patients surgically diagnosed with grade 2-4 glioma (six grade 2, seven grade 3, and 23 grade 4) with known IDH genotypes (23 IDH wild-type, 13 IDH mutant) between November 2021 and August 2023. All patients underwent preoperative perfusion and permeability MRI examinations with a 3.0 Tesla scanner. Parameters were calculated on colored map images. Using the intraclass correlation coefficient, intra- and inter-observer agreement was assessed. Following multiple testing correction, the perfusion parameters with statistically significant differences were subjected to receiver operating characteristic (ROC) analysis.

Results: Five MRI parameters (rCBV and rCBF from perfusion; Ktrans, Ve, and Vp from permeability) showed a significant difference between groups in terms of IDH genotype (p < 0.001). In ROC analysis, the best parameters in differentiating IDH genotype included rCBV and Ktrans; rCBV with a cut-off of 5.58 achieved an area under the ROC curve (AUC), sensitivity, specificity, and accuracy of 0.883, 95.7%, 76.9%, and 88.8%, respectively. For Ktrans, with a cut-off of 0.0727 min-1, these values were 0.893, 100%, 69.2%, and 88.8%, respectively. In ROC analysis, these two parameters with rCBF and Ve also showed good performance in differentiating low- and high-grade gliomas with an AUC, sensitivity, and accuracy exceeding 0.940, 86%, and 88%, respectively.

Conclusion: Perfusion and permeability MRI may provide useful parameters in differentiating the IDH genotype and grade of gliomas.

Aim: To identify the patterns and types of neuorosurgical injuries sustained by victims of the double earthquakes affected ten cities with a population of 15 million in southern and central Türkiye.

Material and methods: In this descriptive observational study, we retrospectively analyzed the medical records of a university hospital located in one of the ten cities affected by the earthquake.

Results: A total of 1,612 patients with earthquake-related injuries were admitted during the study period, of which 139 (8.6%) had neurosurgical injuries. The mean age of the patients was 42.4 ± 21.1 years (median, 42 years), and 53.2% of them were female. Of the 139 patients with neurosurgical injuries, 41 (29.5%) had craniocerebral injuries, 95 (68.3%) had spinal injuries, and three (2.2%) had both craniocerebral and spinal injuries. A total of 31 surgeries were performed (22.3%) (five [3.6%] for craniocerebral injuries and 26 [18.7 %] for spinal injuries). Ninety-eight patients (70.5%) had concomitant systemic traumas. The overall mortality rate was 5.75%, with crush syndrome (n=4, 50%), being the leading cause of death, followed by neurosurgical pathologies (n=3, 37.5%) and pneumonia with septic shock (n=1, 12.5%).

Conclusion: Neurosurgical injury is an important cause of post-earthquake mortality and morbidity. To ensure efficient medical rescue and judicious resource allocation, it is essential to recognize the characteristics of earthquake-related neurosurgical injuries. This study provides valuable information regarding the incidence, characteristics, and outcomes of neurosurgical injuries in earthquake-affected patients. Our findings highlight the need for prompt diagnosis and management of such injuries, particularly in those with concomitant systemic trauma.