Turkish neurosurgery最新文献

Aim: To investigate whether atlantoaxial intra-articular fusion (AIF) can maintain sagittal balance stability in the cervical spine during follow-up.

Material and methods: The data of 39 patients with anterior atlantoaxial dislocation who underwent AIF and 21 patients who underwent structural bone grafting (SBG) fusion were retrospectively reviewed. Radiographic variables, including T1 slope (T1S), C1?C2 angle, C2?C7 angle, C2?C7 sagittal vertical axis (SVA), and lateral atlantoaxial joint space height (LAAJSH), were measured preoperatively, postoperatively, and at the last follow-up. Analyzing the differences in cervical spine curvature and sagittal balance during the preoperative, postoperative, and follow-up periods, as well as identifying the influencing factors.

Results: In the AIF Group, compared to the preoperative measurements, there was a statistically significant increase in both the C1?C2 angle (p < 0.001) and LAAJSH (p < 0.001) at the final follow-up, while a significant decrease was observed in the C2?C7 angle (p < 0.001). At the final follow-up, there was a decrease in LAAJSH compared to immediately post-surgery (p < 0.001), but there were no significant changes in the C1?C2 angle (p=0.366), C2?C7 angle (p=0.502), T1S (p=0.082) and C2?C7 SVA (p=0.209).

Conclusion: Posterior AIF technique can effectively reconstruct the alignment of the atlantoaxial complex and avoid secondary imbalance and loss of lordosis of the subaxial cervical spine.

Subthalamic nucleus deep brain stimulation (STN-DBS) is a safe and effective therapy for Parkinson´s disease (PD) in selected patients. However, various side effects such as paraesthesia, diplopia, ataxia, worsened akinesia, emotional changes, dysarthria, and muscle contractions can occur due to the current spread to the adjacent structures during the STN-DBS programming sessions. Muscle contractions result from the corticospinal and corticobulbar side effects, which can manifest due to the current spread to the pyramidal tract during DBS programming. Here, we report a case of tongue-twisting movement as a unique corticobulbar side effect of the STN-DBS programming in a patient with PD.

Aim: To evaluate the prognostic value of serum endothelin-1 (ET-1), monocyte chemotactic protein-1 (MCP-1), and lactic acid (LA) levels in patients with ruptured intracranial aneurysm (IA) after interventional embolization.

Material and methods: Patients with ruptured IA were divided into mild, moderate, and severe groups according to Hunt-Hess grades, and the correlation between serum parameters and disease severity was analyzed. Multivariate logistic regression was employed to analyze the influence of serum ET-1, MCP-1, and LA levels on the prognosis of patients, and ROC curves were plotted to analyze the predictive value of these parameters.

Results: There were 29 cases in the mild group (grade ?), 49 cases in the moderate group (grade ?-?), and 25 cases in the severe group (grade ?-?). In the severe group, serum ET-1, MCP-1, and LA were elevated compared to the moderate and mild groups, with the moderate group showing higher levels than the mild group. Serum ET-1, MCP-1, and LA levels were positively correlated with the severity of IA (p < 0.05). The Hunt-Hess grade, Fisher grade, and serum ET-1, MCP-1, and LA levels in patients with poor prognosis were higher than those with good prognosis. Hunt-Hess grade ?-?, Fisher grade 3 to 4, ET-1 ? 41.78 pg/mL, MCP-1 ? 229.05 ng/L, and LA ? 7.13 mmol/L were risk factors affecting the prognosis of patients after interventional embolization. The AUC values of serum ET-1, MCP-1, and LA levels to evaluate the prognosis of patients were 0.772, 0.871, and 0.791, respectively.

Conclusion: Serum ET-1, MCP-1, and LA levels correlate with disease severity in patients with ruptured IA and have predictive values for the prognosis of patients after interventional embolization. They are risk factors for poor prognosis of patients after interventional embolization.

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 identify novel therapeutic strategies to improve the outcomes of neonatal hydrocephalus.

Material and methods: The treatment strategies for cases of neonatal hydrocephalus in our hospital between February 1, 2015, and February 1, 2024 reviewed and analyzed, with the aim of identifying valuable factors to assist in treating future patients with critical neonatal hydrocephalus. We further conducted literature searches and summarized the relevant treatment strategies.

Results: A total of 64 neonates were included. The causes of hydrocephalus by case number were as follows: 59.1% due to cerebral hemorrhage, 24.0% due to intracranial infection, and 16.9% due to other causes. Additionally, 32.8% of patients had ultra-low birth weight (ULBW), 14.1% had very low birth weight (VLBW), and 53.1% had low birth weight (LBW). Preterm babies comprised 84.3% of all patients, whereas term babies comprised only 15.7%. Additionally, all treatments for patients involved surgery, with 3.06% undergoing endoscopic third ventriculostomy (ETV), 29.59% undergoing ventriculoperitoneal shunt (VPS), 32.65% undergoing extra-ventricular drainage (EVD), 1.53% undergoing ventriculoatrial shunt (VAS), and 20.41% undergoing Ommaya reservoir. Based on the collected information, we propose a novel two-step surgical treatment process for intensive neonatal hydrocephalus. In the first step, the patient?s physical status (weight and corrected gestational age) is improved and intracranial infection or bleeding are controlled. In the second step, a permanent shunt is placed once the patient meets the surgical criteria.

Conclusion: Based on our experience, we proposed a two-step treatment strategy for the surgical management of critical neonatal hydrocephalus. Moreover, we clarified the detailed criteria for each step of the treatment plan to promote a higher success rate in saving children?s lives. The prognosis of critical neonatal hydrocephalus can be favorable if appropriately treated.

Aim: To investigate the clinical effect of neuroendoscopic surgery on 15 patients with hypertensive brainstem hemorrhage (HBSH).

Material and methods: A retrospective analysis was conducted on the clinical data collected from 15 patients with HBSH and treated with neuroendoscopy between January 2021 and March 2023. Prior to surgery, head computed tomography (CT) data were imported into 3D-slicer software to reconstruct the hematoma in three dimensions, allowing for the calculation of hematoma volume. During surgery, neuroendoscopy was used to clear the hematoma, after which the hematoma clearance rate, along with 30-day and 90-day mortality rates, was calculated. Three months after surgery, the Glasgow Outcome Scale (GOS) was used to evaluate patient prognosis, calculate the good recovery rate, and assessed surgical efficacy.

Results: Re-examination of head CT images within 24 hours post-surgery revealed a hematoma clearance rate of > 90% in 11 cases and over 80?90% in four cases, with a mean hematoma clearance rate of 90.52±3.85%. There were no complications associated with postoperative rebleeding, intracranial infection, or the leakage of cerebrospinal fluid. Mortality rates on days 30 and 90 post-surgery were 26.7% (4/15) and 40% (6/15), respectively. After a 3-month follow-up period, GOS prognostic scoring revealed that one case had recovered well and could live a normal life, two cases had mild disability, and two cases had severe disability. Four patients survived in a vegetative state while six patients died; the good prognostic rate was 20% (3/15).

Conclusion: Neuroendoscopic technology is safe and effective for the treatment of HBSH. This method has a high hematoma clearance rate and a good clinical treatment effect with few postoperative complications.

Aim: To report a series of pediatric intracranial meningiomas operated in a single institution, and to compare their features with the literature.

Material and methods: Using our hospital?s automation system, patients under the age of 18 who had been operated in the last 11 years were identified. Data from these patients were collected and compared with the literature.

Results: The mean age was 7.9 years old. Of the 10 patients, 8 (80%) were males, 2 were females (20%). The most common symptoms were cranial nerve palsies. When all MR and CT images were evaluated, peritumoral oedema was observed in 6 of the patients (60%), dural tail in 7 patients (70%), bone destruction in 3 patients (30%), and intratumoral calcification in 2 patients (20%). Histopathological diagnosis was made according to the World Health Organisation classification (2021) into grades 1, 2, and 3. Three patients (30%) had a typical meningioma (grade 1), and 7 patients (70%) had an atypical type (grade 2). Recurrence occurred in one of four patients with residual tumours.

Conclusion: Subtle and careful surgical approaches are the main treatment option and postoperative prognosis for pediatric meningiomas. Contrary to previous studies, the association of meningiomas with radiation exposure and NF was not common in our series. Further research is needed to understand the reasons for the differences between the pathophysiology of pediatric meningiomas and the adult form to ensure successful treatment.