Turkish neurosurgery最新文献

Aim: To examine the correlation between clinical outcomes and electrophysiological findings following open carpal tunnel release (CTR) surgery in patients with a positive scratch collapse (SC) test, and to the postoperative course of the SC test.

Material and methods: The study included 29 patients who had a positive SC test and a confirmed diagnosis based on nerve conduction study (NCS) findings. The findings of Boston Carpal Tunnel Questionnaire (BCTQ), visual analog scale (VAS), NCS, and SC test were assessed preoperatively and postoperatively at the 2nd and 8th weeks. The correlations between NCS findings and BCTQ and VAS scores were analyzed.

Results: Significant postoperative improvements were observed in BCTQ and VAS scores at the 2nd and 8th weeks. In the 8th week, NCS findings also showed significant improvement; however, no correlation was found between NCS findings and functional scores. The SC test became negative in 89.6% (n=26) of patients postoperatively.

Conclusion: In the early period following open CTR surgery, there is no correlation between improvements in NCS findings and functional scores. However, in 90% of patients with a positive preoperative SC test, the test became negative early after the open CTR surgery. Therefore, the SC test can be used to evaluate postoperative treatment results because it is easily applicable, repeatable, and cost-effective compared with NCS.

Aim: To assess the contributions of Turkish female authors to the field of neurosurgery through ?Turkish Neurosurgery?, the only neurosurgery journal in Türkiye indexed by The Science Citation Index Expanded (SCIE).

Material and methods: A bibliometric analysis was conducted on articles published in ?Turkish Neurosurgery? from 2019 to 2023. Data were gathered on authorship, gender distribution, article types, topics, and institutional affiliations. Statistical analyses included chi-square tests, the Cochran?Armitage test, and logistic regression to evaluate the association between female senior and first authorship.

Results: Of the 751 articles reviewed, 505 featured contributions from at least one Turkish author, comprising 2,601 Turkish contributors (24.8% female, 74.4% male). Turkish female authors appeared in 292 of these publications (57.8%), serving as first authors in 103 (20.4%) and senior authors in 92 (18.2%). The proportion of Turkish female first authorship increased significantly over the study period, peaking at 31.2% in 2022 (p=0.049). Logistic regression analysis revealed that the presence of a Turkish female senior author significantly increased the likelihood of female first authorship (OR = 3.96, p < 0.001). Only 16.2% of Turkishauthored articles included female neurosurgeons. Of all Turkish female authors, 23.6% of first authors and 19.6% of senior authors were neurosurgeons. Most publications by Turkish female authors (59.7%) were original research articles, primarily focusing on neuro-oncology, spine, and functional neurosurgery.

Conclusion: This study highlights encouraging progress in the representation of Turkish female authors, particularly neurosurgeons, who exhibit strong academic engagement relative to their workforce proportion in neurosurgical academic publishing. Mentorship plays a crucial role in increasing female first authorship. To strengthen this effect, academic institutions could implement structured mentorship programs, fund collaborative research, and establish platforms to connect senior and junior female researchers.

Aim: To provide an in-depth anatomical description of the bed nucleus of the stria terminalis (BST) and its structural affiliations, with an emphasis on its surgical and neuromodulatory relevance.

Material and methods: We conducted stepwise fiber dissections on 14 formalin-fixed human brains prepared using the Klingler method. Under high magnification, dissections were performed lateral to medial and medial to lateral directions, enabling detailed visualization of the BST?s relationship with adjacent fiber tracts and nuclei such as the anterior commissure, fornix, stria terminalis, nucleus accumbens, and septal area.

Results: The BST was consistently located anterosuperior to the anterior commissure and medially bordered by the septal nuclei, forming a compact yet integrative structure. Dense projections were identified between the BST and limbic-hypothalamic targets via the stria terminalis, fornical fibers, and the diagonal band of Broca. These connections emphasize the BST?s pivotal position in coordinating limbic output with neurovegetative centers.

Conclusion: This study refines the topographic and connectional map of the BST, offering structural insight into its role as a limbic hub. Such clarity may assist in tailoring neuromodulatory interventions?such as deep brain stimulation?by improving anatomical precision in disorders involving fear, compulsion, and affect regulation.

Arteriovenous malformations (AVM) are abnormal arteriovenous shunt lesions that predominantly occur in the brain or spinal cord. However, obstructive hydrocephalus resulting from an unruptured AVM occurs rarely. Herein, we report the case of a patient with obstructive hydrocephalus caused by an unruptured cerebellar AVM that was treated with an endoscopic third ventriculostomy (ETV), and further, we present a literature review. An 11-year-old girl presented to our department with headache, nausea, and vomiting. Magnetic resonance imaging and angiography revealed a cerebellar AVM. Additionally, we used the findings of digital subtraction angiography and confirmed a Spetzler?Martin grade 5 cerebellar AVM fed by branches of the bilateral posterior cerebral and bilateral anterior and posterior cerebellar arteries. We initiated conservative therapy; however, 10 years after her initial presentation, the patient?s acute obstructive hydrocephalus due to aqueductal occlusion had worsened. Therefore, we performed an endoscopic third ventriculostomy that resolved the hydrocephalus and improved the patient?s clinical condition. In our review of the literature, we observed that, in most cases, hydrocephalus resulted from deep-seated AVM; furthermore, ETV effectively resolved the hydrocephalus. To summarize, ETV can be an effective alternative to emergent ventriculoperitoneal shunting to treat acute obstructive hydrocephalus caused by unruptured intracranial AVM.

Aim: To investigate the therapeutic efficacy of quercetin in early brain injury (EBI) and vasospasm resulting from experimental subarachnoid hemorrhage (SAH).

Material and methods: The rats were assigned into five groups, as follows; Group A: rats did not undergo SAH induction, Group B: rats underwent SAH induction, but received no treatment, Group C: rats underwent SAH induction and received dimethyl sulfoxide (DMSO) intraperitoneally, Group D: rats underwent SAH induction and followed by the intraperitoneal administration of 10 mg quercetin, Group E: rats underwent SAH induction, followed by the intraperitoneal administration of 50 mg quercetin. After the procedure, each group of rats received DMSO, 10 mg/kg quercetin, or 50 mg/kg quercetin intraperitoneally at 30 minutes, 12 hours, and 24 hours, according to their respective categories. The oxidative stress index (OSI) was biochemically measured using the total oxidant status and total antioxidant status. The serum caspase-3, glutathione peroxidase-1 (GPX), and malondialdehyde (MDA) levels were measured.

Results: Brain injury and vasospasm after SAH led to a decrease in the serum GPX levels and an increase in the caspase-3, MDA, and OSI levels. Vasospasm induced an increase in the wall thickness and a narrowing of the lumen diameter in the basilar artery. Treatment with quercetin increased the GPX level and decreased the caspase-3 and MDA levels. Treatment with quercetin reduced the wall thickness and increased the lumen diameter of the basilar artery.

Conclusion: Quercetin may be a novel, effective therapeutic option for the treatment of cerebral vasospasm and brain injury by reducing apoptosis, oxidative damage, vessel wall thickness, and vasoconstriction.

Aim: To investigate the effects of 25% dextrose in a rat model of cerebrospinal fluid leakage.

Material and methods: Forty Wistar rats were included in the study. The dura mater of the rats was opened, and 25% dextrose was applied topically at a dose of 0.1 ml. Rats were sacrificed at the end of the third and sixth weeks. Then, pathologic and electron microscopic evaluations were performed.

Results: The results of healing score and fibroblast density evaluations showed that dextrose led to more successful healing than control subjects in early and late postoperative evaluations. In addition, electron microscopic examination showed that fibroblasts had active endoplasmic reticulum and mitochondria in a large cytoplasm, indicating increased collagen secretion.

Conclusion: After dura mater injury, 25% dextrose, a cheap and accessible agent, has the potential to be used to enhance healing.

Aim: To discuss the diagnostic tests and management options of retroclival Ecchordosis physaliphora (EP).

Material and methods: Four patients with a retroclival EP were assessed. Computerized tomography (CT) and magnetic resonance imaging (MRI) findings were examined thoroughly. Diffusion MRI characteristics were also evaluated. Furthermore, our management protocol has been discussed.

Results: A total of 4 patients with a retroclival EP exhibited similar imaging findings. CT revealed bone changes and a stalk-like connection between the clivus and EP. MRI revealed a lesion that was hyperintense on T2-weighted images and hypointense on T1-weighted images. Neither of the lesions showed contrast enhancement. All lesions were surgically resected. Histopathological examination of the lesions confirmed the diagnosis of benign notochordal remnant.

Conclusion: The approach and timing of surgery should be determined according to the lesion parameters in each patient. Large heterogenous lesions that have caused significant bone changes require timely surgery. Small homogenous lesions with a stalk-like connection to clivus should be closely monitored.

Aim: To evaluate the efficacy and safety of the guideless catheter placement technique in revision surgeries for external ventricular drainage (EVD) and ventricular shunt systems to improve treatment outcomes for hydrocephalus.

Material and methods: We retrospectively analyzed 111 patients who underwent revision surgeries for EVD or ventricular shunt systems at the Istanbul Umraniye Training and Research Hospital from January 2020 to January 2023. Patients' demographic (age, sex), and clinical (cause of hydrocephalus, type of surgery, and postoperative complication rates, specifically for bleeding and catheter malposition) data were extracted from the patient files.

Results: The use of the guideless catheter placement technique significantly reduced postoperative complications, with notably lower rates of bleeding (n=2, 1.8%) and catheter malposition (n=5, 4.5%).

Conclusion: The guideless catheter placement technique is a viable, cost-effective, and efficient approach for revision surgeries in EVD and shunt systems, which can potentially improve the safety and accuracy of catheter placement, reduce complication rates, and ensure favorable patient outcomes associated with revision surgeries for hydrocephalus.

Intraventricular hydatid cysts are extremely rare. Till date, these cysts have been believed to originate from the ventricle itself. Of the various intraventricular cysts, primary solitary cysts are the most common ones. These cysts are purely intraventricular or partly parenchymal with an intraventricular spread. These cysts have so far never been reported to spread contiguously from the extradural location, breach the dura, and thereafter, migrate intraventricularly. Here, we present a unique case of intraventricular spread of an extracerebral hydatid cyst after a dural breach. The ability of hydatid cysts to breach the dura has not been described previously. The pathogenesis of the hydatid cyst has been discussed here along with its surgical and medical management.

Aim: To evaluate association between chronic subdural hematoma (CSDH) and thromboelastography (TEG).

Material and methods: A prospective pilot study was conducted on 52 patients with CSDH. The primary outcomes were CSDH severity, recurrence rate, and outcome. The secondary outcome was the association between TEG parameters and the risk factors of CSDH.

Results: The association between the preoperative TEG parameters and the primary outcomes was compared. Results revealed no statistically significant association between the primary outcomes and admission modified Rankin scale score and follow-up GOS score. The R values significantly differed between patients with recurrence and those without (p=0.045). Further subgroup analysis of TEG parameters revealed that patients with R values ≥ 5 had a significantly high incidence of recurrence (1.231, 95% confidence interval [CI]: 0.973-1.557], p=0.025). However, further logistic regression analysis did not reveal significant results (1.198, 95% CI: 0.855-1.680, p=0.293). Moreover, the association between the preoperative TEG parameters and the secondary outcomes was compared. Results revealed a statistically significant association between the secondary outcomes and hematoma thickness and LY30 values (p=0.039), midline shift and Angle (p=0.043), and multiplicity of the hematoma cavity and MA (p=0.022). Further, the secondary outcomes were also significantly associated with postoperative TEG parameters such as multiplicity of the hematoma cavity and LY 30 value (p=0.011) and residual hematoma at follow-up (MA, p=0.001).

Conclusion: Due to the small sample size, the efficacy of TEG parameters in predicting CSDH recurrence is unclear. However, TEG parameters are associated with the imaging characteristics of CSDH, and they can also be used to predict the absorption of hematoma. Nevertheless, large-scale prospective cohort studies should be performed to further validate the findings of this study.