Turkish neurosurgery最新文献

Aim: To evaluate the occurrence of proximal junctional kyphosis (PJK) as well as both the clinical and radiologic outcomes of patients who underwent surgery for Scheuermann?s Kyphosis (SK) using either exclusively pedicle screws or a combination of proximal hooks and pedicle screws constructs.

Material and methods: Surgically treated 37 patients with the diagnosis of SK were evaluated retrospectively. The patients were divided into two groups based on the type of instrumentation employed. The first group contained 22 patients with only pedicle screws (PP) while the second group consisted of 15 patients with mixed constructs that were proximal hooks and pedicle screws (HP) at the rest of the levels. The clinical and radiological data were compared in patients who were followed up for a minimum of 2 years.

Results: The average duration of follow-up for the PP group was approximately 94.7 ± 53.1 months, whereas the HP group had an average follow-up period of around 103 ± 64.4 months. After conducting the analyses, no statistically significant findings were identified in the measurements taken for the SRS-22 scores in preoperative, postoperative, and the most recent follow-up radiographs (p > 0.05). It is worth noting that among patients who exclusively utilized pedicle screws, both the proximal (p=0.045) and distal (p=0.030) junctional kyphosis angles experienced more pronounced increases compared to hybrid structures.

Conclusion: While no notable distinction was observed between the two groups, patients with pedicle screws fixation had a higher PJK angle. Conversely, the use of hooks at the upper end seems to be a preventive measure against the development of PJK.

Taste consists of sensation and perception. Specific neural structures transmit a stimulus from the taste buds to the gustatory cortex to generate taste sensation. Any disruption of this pathway, whether it affects sensation or perception, can result in taste disorders. Stereotactic procedures involving the thalamus may result in gustatory complications. A 41-year-old female patient who underwent stereotactic drainage of a thalamic cyst suffered transient ageusia. Subsequently, she developed metallic taste perception. When her stereotactic plan was re-evaluated, it was noted that the posteromedial ventral thalamus nucleus was in the path of the needle tract and the needle had passed through it. Follow-up was recommended and her symptoms completely resolved within 2 months following surgery. Modern imaging techniques allow for the visualization of neural structures related to the sense of taste. Additionally, care must be taken when planning stereotactic procedures for such lesions.

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 investigate the effects of vitamin D and memantine on the healing process in juvenile rats with repetitive brain injury (rTBI) and to elucidate the mechanisms underlying these potential therapeutic effects.

Material and methods: Juvenile rats were randomly allocated into seven groups, with eight rats per group: sham-operated (Group I), trauma (Group II), memantine supplementation (10 mg/kg) pre-trauma (Group III), vitamin D supplementation (5 µg/kg) pre-trauma (Group IV), vitamin D supplementation post-trauma (Group V), memantine and vitamin D supplementation post-trauma (Group VI), and vitamin D supplementation pre- and post-trauma with post-trauma memantine supplementation (Group VII). A modified repeated weight drop model was employed to induce rTBI. Brain tissues and blood samples were collected for analysis. Expressions of the mammalian target of rapamycin (mTOR), temporary receptor potential (TRPM2), and GABA receptors were assessed via immunohistochemistry. Levels of 8-hydroxy-2-deoxyguanine (8-OHdG) were determined using high-performance liquid chromatography (HPLC). Matrix metalloproteinases -2 and -9, tissue inhibitors of metalloproteinases-1 and-2, and NADPH oxidation-4 levels were determined using commercially available enzyme-linked immunosorbent Test kits. Immunohistochemistry analyses were performed on the brain cortex and hippocampus.

Results: The levels of 8OHdG/106dG, MMP-2, MMP-9, TIMP-1, -TIMP2, and NOX-4 were significantly higher in the trauma group than in the other groups. No difference was found between the control and Pre Vit D+Mem+Post Vit D groups regarding 8OHdG/106dG, MMP-2, -9 and NOX-4 levels. Normalized expressions of mTOR and TRPM2 were observed in Groups VI and VII. Conversely, GABA expression levels decreased in Group II, with the most pronounced therapeutic effects observed in Group VII.

Conclusion: Memantine and vitamin D positively affected rTBI when used alone. Their combined use exhibited greater therapeutic outcomes. These effects are mediated by mTOR mRNA, TRPM2 mRNA, and GABA mRNA expressions.

Aim: To compare the treatment outcomes of surgical and endovascular methods in patients with intracranial aneurysms.

Material and methods: A total of 1183 patients [722 (61%)] female and 461 [(39%) male] with intracranial aneurysms, including 615 with subarachnoid hemorrhage (SAH) and 568 without hemorrhage, were retrospectively reviewed.

Results: The mean age of patients was 51.3 ± 12.4 years. Male patients were significantly more likely to have aneurysmal hemorrhage at admission (p < 0.001). Surgical intervention was performed in 462 (39.1%) patients, and endovascular methods were used in 541 (45.7%) patients. Sixty-five (5.5%) patients were treated with both methods. The World Federation of Neurosurgical Societies grade was found to have a strong negative effect on the Glasgow Outcome Scale (GOS) score (Wald = 21.81). The GOS scores were significantly higher in the surgical treatment group than in the endovascular treatment group for aneurysms in the anterior communicating artery. Based on follow-up digital subtraction angiography, the complete occlusion rate of the aneurysm was significantly higher with the surgical method than with the endovascular method (p < 0.001). The complete closure rate of aneurysms following endovascular treatment was significantly lower than that after surgical treatment (p < 0.001). However, we found no significant difference between the two methods in terms of residual aneurysms requiring reintervention.

Conclusion: Treatment of intracranial aneurysms should be decided jointly by an experienced team of neurovascular surgeons, neuroradiologists, and anesthesiologists.

Aim: To explore the pathophysiological mechanism of subarachnoid haemorrhage (SAH) using cellular oxidative stress mechanisms and inflammation.

Material and methods: A total of 20 Wistar Albino rats were divided into two groups, namely sham and SAH. On day 0, 0.3 mL of saline in the sham group and 0.3 ml of autologous blood in the SAH group were applied in the cisterna magna of the animals. After sacrification on the 7th day of the procedure, brain, blood and heart tissues were collected. In different tissues, total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), creatin kinase MB (CKMB) and lactate dehydrogenase (LDH) levels were detected biochemically. AKT, sirtuin-1 (SIRT-1), NF-E2-related factor 2 (NRF2), heme oxygenase-1 (HO-1) genes and glutathione peroxidase-4 expression were examined genetically. Moreover, histopathological analyses were conducted both in heart and brain tissues.

Results: Enhanced TOS, OSI levels in all tissues and glial fibrillary acidic protein (GFAP) expressions in brain tissue and NFkβ, IL-6 and Cox-1 expressions in heart tissues; it was observed that levels of TAS in blood and AKT, SIRT-1, NRF2 and HO-1 gene expressions in brain tissue were decreased.

Conclusion: In the oxidative stress and inflammation situation that takes place following SAH, AKT, SIRT-1, NRF2 and HO-1 pathways, which are antioxidant mechanisms, are suppressed and GFAP, NFkβ, IL-6, Cox-1 expressions, which trigger inflammation, are enhanced. Treatment of SAH necessitates studies on the inhibition or activation of such pathways.

Vagal paragangliomas (VPs) are rare tumors arising from paraganglionic tissue within the vagal nerve's perineurium. Usually, benign vascular tumors, VPs tend to invade the surrounding structures. Herein, we report the case of a VP presenting as a neck mass, which was evaluated as a glomus caroticum tumor preoperatively. A 65-year-old female complaining of a left-sided neck mass and intermittent hoarseness was assessed and operated on for possible glomus caroticum tumor. During the tumor excision, the vagal nerve was also involved, and hence, sacrificed. Histopathological examination revealed an encapsulated tumor associated with a nerve and ganglion and immunohistochemical staining tested positive for succinate dehydrogenase, confirming the diagnosis of VP. Postoperative residual hoarseness was corrected by vocal rehabilitation. While evaluating a retropharyngeal prestyloid neck mass, a VP should always be considered. Surgical excision involving vagal scarification, followed by vocal rehabilitation may be the appropriate treatment strategy.

Aim: To determine whether there is a correlation between a deeply seated L5 vertebra in relation to the intercrest line (ICL) and the level of degeneration of lumbar discs.

Material and methods: The study included 152 patients who underwent surgery for lumbar disc herniation. After analyzing the radiographs, the patients were separated into two groups. Group 1 patients had an ICL that passed through the L4 corpus, and Group 2 patients had an ICL that passed through the L4-5 disc distance or the L5 vertebra. Group 1 patients were classified as having a deeply seated L5 vertebra, while Group 2 patients were classified as not having a deeply seated L5 vertebra.

Results: The study found that male patients had a significantly higher incidence of a deeply seated L5 vertebra compared to female patients (p=0.003). Patients who underwent surgery at the L4?5 level exhibited disc heights that were notably higher than those who underwent surgery at the L5-S1 level. In Group 1, 68% of the patients had surgery at the L4-5 level, compared to only 41.7% in Group 2 (p=0.009).

Conclusion: When investigating the effects of the position of the L5 vertebra in relation to the ICL at the L4-5 and L5-S1 disc levels, the study found that having a deeply seated L5 vertebra protected against L5-S1 disc herniation and that L4-5 disc herniation was more common in these patients. This is believed to be due to the L5?S1 segment being less mobile when the L5 vertebra is deeply seated.

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.