Turkish neurosurgery最新文献

Aim: To investigate the neuroprotective effects of various amounts of syringic acid (SA) on cerebral damage resulting from experimentally induced subarachnoid hemorrhage (SAH) in rats, utilizing both histological and biochemical analyses.

Material and methods: In total, 40 male Wistar albino rats were randomly and equally assigned to four groups: Control, SAH, SAH + 50 mg/kg/day SA (po), and SAH + 250 mg/kg/day SA (po). The rats in the SAH, SAH + 50 mg/kg/day SA, and SAH + 250 mg/kg/day SA groups were induced with SAH by administering 0.15 mL of autologous blood, collected from each rat?s heart, into the subarachnoid space through the foramen magnum. On day 10th, the rats were sacrificed, and their blood and brain tissues were collected for biochemical, and histological analyses.

Results: Glutathione peroxidase levels were considerably elevated in the SAH + 250 mg/kg/day SA group compared to both the control and SAH groups. Although not statistically significant, IL-6 levels were lower in the SAH + 250 mg/kg/day SA group compared with those in the control group. In the SAH + 250 mg/kg/day SA group, the histological and cellular damages in the cortical brain tissue reduced significantly.

Conclusion: SA (250 mg/kg/day) ameliorated the oxidative and histopathological changes in blood profile and cerebral tissue of rats when exposed to experimentally induced SAH. Thus, SA can reduce secondary cerebral damage in an SAH-induced rat model.

Aim: To elucidate the effects of nasal and intraperitoneal dexmedetomidine (DexN and DexP, respectively) administration in an animal model, and to explore the underlying action mechanisms on the treatment of traumatic brain injury (TBI).

Material and methods: A total of 31 Wistar albino rats served as a weight-drop model to induce experimental TBI. The two treatment groups received DexN and DexP on the day of the trauma and then after 5 days. The Garcia test was performed for the neurological evaluation along with histopathological and biochemical analyses.

Results: The rats in the treatment group displayed better neurological outcomes, as evidenced by a higher Garcia test score (p < 0.001). DexP group presented with increased anti-inflammatory and neuroprotective effects in comparison to DexN (p < 0.001). DexN group demonstrated a reduction in the neuron specific enolase (NSE) levels (p=0.023), indicating that it inhibited the neuronal destruction.

Conclusion: The present study support the hypothesis that a psychoactive drug, Dex, which has been conventionally used for sleep disorders and is also known for its cognitive-enhancing properties, may have beneficial effects after TBI owing to its antiinflammatory, anti-oxidative, and neuroprotective properties.

Aim: To compare the effect of fusion with anterior plating and cage (PLATE) versus cage-only (CAGE-O) technique on postoperative cervical sagittal alignment parameters, clinical outcome, and complication profiles after two-level anterior cervical discectomy and fusion (ACDF).

Material and methods: Clinical and radiological data of 42 patients who underwent two-level ACDF with either cage-only or anterior plating were retrospectively analyzed. Sagittal alignment parameters, including cervical lordosis, C0-C2 angle, T1 slope, and cervical sagittal vertical axis (cSVA), were evaluated preoperatively and postoperatively. Clinical outcomes were analyzed using the visual analog scale (VAS) and Neck Disability Index (NDI) scores.

Results: Both groups showed significant clinical improvement in VAS and NDI scores over a 2-year follow-up period. Postoperatively, the CAGE-O group exhibited a significant increase in T1 slope and C0-C2 angles, whereas the PLATE group did not. Cervical lordosis and cSVA values showed no significant change postoperatively in both groups. Complication rates were similar between both groups.

Conclusion: Both anterior plating and cage-only techniques in two-level ACDF demonstrated comparable outcomes in terms of sagittal alignment, clinical improvement, and complication rates. The decision to utilize anterior plating should be based on individual patient factors and surgeon preference rather than differences in outcomes.

Aim: To determine the prognostic value of routine hematological indices in patients undergoing carotid endarterectomy (CEA).

Material and methods: As a retrospective single center study, we measured the systemic immune inflammation index (SII) and other systemic inflammatory parameters to estimate the morbidity and mortality of patients undergoing CEA. These parameters include inflammatory markers which are included in routine preoperative haematologic tests like complete blood count (CBC).

Results: After the analysis of the collected datas from 72 patients, the results showed that inflammatory indices were significantly different in patients with different clinical courses.

Conclusion: Inflammatory parameters calculated from routine preoperative hematologic parameters proved to be important predictive parameters that can be used in morbidity/mortality estimation of patients scheduled for CEA.

Aim: To examine intraoperative cone-beam computed tomography (iCBCT) accuracy, and the need for postoperative imaging to confirm electrode position, and to assess the complications of deep brain stimulation (DBS) surgery.

Material and methods: Thirty-two movement disorder patients and 69 targets were retrospectively reviewed. All patients had preoperative non-stereotactic 3.0 Tesla magnetic resonance imaging (MRI), preoperative stereotactic multidetector computed tomography (MDCT), post-implantation iCBCT, and postoperative conventional MDCT scans. Stereotactic coordinates of electrode tips were compared between postoperative MDCT and iCBCT. We calculated the absolute and Euclidian differences (ED) between iCBCT and postoperative MDCT coordinates for each electrode. To assess whether intraoperative brain shifting influenced electrode tip localisation, subdural pneumocephalus volume was measured in iCBCT images.

Results: The mean absolute (scalar) differences in x, y, and z coordinates were not significantly different from the absolute precision value of 0 (p > 0.05). The mean ED between the iCBCT electrode tip and the postoperative MDCT electrode tip coordinates was < 1mm (0.55±0.03 mm) and differed significantly from zero (p < 0.0001). There was no correlation between pneumocephalus volume and electrode coordinate deviation.

Conclusion: iCBCT can eliminate the need for routine postoperative studies since it is a safe, effective, and rapid procedure that can be performed at any step of the surgery. It provides reliable and definitive confirmation of correct DBS electrode placement.

Aim: To assess the safety and efficacy of using Two isocenter targets in Gamma Knife Radiosurgery (GKRS) for treating trigeminal neuralgia (TN) versus a single isocenter target solely at the root entry zone (REZ).

Material and methods: A retrospective study was conducted.The study involved 171 patients with severe facial pain caused by TN. Pain intensity was measured using a pre/post-BNI scale. Group A (85 patients) received 90 Gy using a single isocenter at REZ with a 4mm collimator, while Group B (86 patients) received 90 Gy at two isocenters of the REZ and distal cisternal segment. Statistical analyses were done to assess differences between post-BNI scores and pain-free durations in the groups.

Results: Both groups had a mean patient age of 50 years. Group A had a longer presurgical pain duration (98 months) than Group B (78 months). In Group A, 33% reported pain relief to BNI class II and 67% to class III, while in Group B, 70% reported pain relief to BNI class I and 30% to BNI class II. Group A had a 40% 8-week pain relief rate, while Group B had a higher percentage of painfree durations of 6-7 weeks (21%) and 9 weeks (39%). Group B had a higher incidence of post-op facial numbness (27% vs. 14% in Group A). Significant differences existed between post-BNI pain intensities and pain-free durations in both groups.

Conclusion: Patients who received 90 Gy radiation at two isocenters had better outcomes than those with a single isocenter for GKRS. While Group B experienced earlier pain relief, Group A had fewer side effects. Two-isocenter GKRS is a safe and effective alternative for TN patients with a better pain management profile but an increased risk of facial hypoesthesia.

Aim: To compare the effects of pregabalin and gabapentin on the regeneration of rat nerves exposed to experimental axonotmesis by means of histomorphological, immunohistochemical, biochemical, electrophysiological, and clinical evaluations.

Material and methods: Thirty-two female Sprague-Dawley rats were divided into four groups of eight animals each; Group 1 (control), Group 2 (axonotmesis + normal saline), Group 3 (axonotmesis + pregabalin 30 mg/kg), and Group 4 (axonotmesis + gabapentin 30 mg/kg). Medical treatment was given for the first seven days to groups 3 and 4. Functional recovery was assessed using electromyography (EMG) and the sciatic functional index (SFI). Sciatic nerves were excised for histomorphological, immunofluorescence, and immunohistochemical examinations. Biomarkers were measured using the enzyme-linked immunosorbent assay method.

Results: Significant improvement in SFI scores and EMG measurements were observed on the 28th day in groups 3 and 4 (the treated groups), while Group 2 (untreated) exhibited inadequate recovery. Histomorphological and immunohistochemical analyses revealed notable decreases in Wallerian degeneration, necrosis, inflammation, and nuclear factor-kappa B (NF-?B) expression levels in the treated groups compared to Group 2. The groups receiving medical treatment exhibited increased staining areas for nerve growth factor (NGF). Biochemical assessment indicated elevated levels of NGF, ciliary neurotrophic factor, transforming growth factor beta, and myelin basic protein in the treated groups compared to Group 2.

Conclusion: Overall, the study findings suggest that both pregabalin and gabapentin exert neuroprotective effects and can contribute to the regeneration process, with no apparent superiority of one over the other.

Aim: To establish the presence and amount of fluid accumulation in UBE procedure, and the relationship of fluid management with other variables.

Material and methods: All patients underwent UBE spinal surgery with one level between September 2019 and February 2022. The exclusion criteria were determined. All early MRI-STIR images from all patients up to the 12th-h postoperatively were collected. All MRI STIR images were evaluated by matrix laboratory (MATLAB) for fluid accumulation. Statistical analysis was done by SPSS 22.0 (IBM, Armonk, NY).

Results: The hospital archive records of 39 patients were assessed in this study. The mean matrix laboratory measurements (cm3) for women was 58.75 ± 18.870 and that for men was 49.86 ± 18.977. No significant difference was found in terms of gender in matrix laboratory value (p=0.161). Matrix laboratory value was negatively correlated with height but positively correlated with BMI and the subcutaneous adipose tissues. There was no significant difference between the genders in terms of age, BMI, and matrix laboratory.

Conclusion: Any complications of fluid accumulation in the UBE study group were not detected. The fluid accumulation in UBE was within physiological limits. Matrix laboratory is a good and applicable method for spine surgery.

Aim: To compare the results of surgical correction of adolescent idiopathic scoliosis (AIS) by posterior instrumentation using the conventional all pedicle screw fixation method (PS) and the hybrid fixation method utilising the sublaminar bands along with pedicle screws (HG).

Material and methods: The study adheres to Preferred Reporting Items for Systematic reviews and Meta Analysis (PRISMA) and was registered with PROSPERO. This review included studies conducted on patients having AIS. All studies comparing the outcomes of PS with HG were included.

Results: We found an improvement of the main curve (p=0.007; SMD (IV, Random) = 0.54; 95% CI [0.15, 0.93]) in the PS group to be statistically significant. The two groups had statistically insignificant differences in the operative time, blood loss, number of levels fused, secondary curve correction and complication rates. We found PS had better outcomes in cases with preoperative hyperkyphosis whereas HG was better for patients with preoperative hypokyphosis. The complications on ling term follow up in the form of distal junctional kyphosis 2 years after surgery is higher in PS (5%).

Conclusion: Hybrid constructs using sublaminar bands along with pedicle screws are safe and effective option for posterior instrumentation of AIS due to reduced incidence of complications like distal junctional kyphosis. They give better deformity correction in sagittal planes hence are more effective in restoring the dorsal kyphosis post-operatively.

Aim: To evaluate pial arteriovenous fistulas (AVFs), focusing on the radio-anatomic architecture and contemporary endovascular devices and techniques.

Material and methods: Sixteen patients with congenital pial AVFs who underwent endovascular treatment between 2002 and 2023 at a single institution were included in this review. This retrospective study was approved by the Institutional Review Board. The study was descriptive and involved no statistical comparisons.

Results: The study included 16 patients (6 female patients, 10 male patients) with a mean age of 19.93 ± 21.1 years (range: 1?63 years). Nine (56.25%) were pediatric patients, six (37.5%) of whom were younger than 5 years. Five patients (31.25%) had more than one feeding artery, whereas 11 (68.75%) had a single feeding artery. One patient had two separate fistulas. All fistulas were successfully occluded without complications. Four patients (25%) were treated with glue alone, four (25%) with coils alone, five (31.25%) with a non-adhesive liquid agent alone, and three (18.75%) with a combination of coils and a non-adhesive liquid agent. Venous sinus thrombosis occurred in two patients (12.5%) in the early postoperative period; both cases resolved without permanent deficits.

Conclusion: Pial AVF is a rare intracranial vascular malformation. Endovascular treatment using liquid embolic agents, coils, or a combination of these techniques is effective.