Turkish neurosurgery最新文献

Aim: To examine the effects of amantadine, a drug with neuroprotective and anti-inflammatory activities on oxidative stress, tissue necrosis, apoptosis, and neurological recovery in an experimental rabbit spinal cord ischemia-reperfusion injury (SCIRI) model.

Material and methods: A total of 32 rabbits were randomized into five groups: control, ischemia, vehicle, methylprednisolone (MP), and amantadine (AMT) (n=8/each). At 24th-hour neurological examination was performed, spinal cord tissues were collected, and biochemical and histopathological examinations were performed.

Results: When ischemia and vehicle groups were compared with control group, significant increase was seen in serum and tissue caspase-3, malondialdehyde (MDA), and myeloperoxidase (MPO) levels (p < 0.001); significant decrease was seen in serum and tissue catalase (CAT) levels (p < 0.001); and significant increase was seen in serum xanthine oxidase (XO) levels (p < 0.001). When the ischemia group and the MP and AMT groups were compared, low serum and tissue caspase-3 levels (p < 0.001), high serum and tissue CAT levels (p < 0.001), significantly low serum XO levels (p < 0.001), low serum and tissue MDA levels (p < 0.05) and tissue MPO levels (p < 0.001) were found. Both AMT and MP groups showed decreased histopathological score and higher number of normal neurons (p < 0.001) compared to ischemia group. Both AMT and MP showed better modified Tarlov scores compared to the ischemia group (p < 0.001).

Conclusion: Our study found that AMT had antioxidant, anti-inflammatory, anti-apoptotic, and neuroprotective effects on SCIRI. We used biochemical, microscopic, and ultrastructural approaches to demonstrate these effects. AMT might be a candidate medication for SCIRI prophylaxis and treatment.

Aim: To evaluate coagulation related gene model as a biomarker for predicting prognosis of gliomas.

Material and methods: The mRNA expression and clinical data of glioma were downloaded from the TCGA and CGGA databases. Coagulation-related genes were downloaded from the KEGG database. The expression model was constructed using LASSO regression. The GBM data were divided into high and low-risk expression groups based on the median risk score, and the differences in overall survival and progression-free survival between them were calculated. The prognostic model was further validated using the TCGA-LGG and CGGA glioma databases, respectively. The accuracy of the risk score was calculated by ROC analysis for 1 year and 3 years.

Results: Four model genes, namely the SERPINA5, PLAUR, BDKRB1, and PTGIR, were identified, and the risk score was calculated as follows: risk score= SERPINA5*0.126264111304559 + PLAUR*0.288587629696211 + BDKRB1*0.349215422945011 + PTGIR*0.17334527969703, respectively. Based on glioma data from three groups, patients were divided into high and low-risk groups according to the median risk score. The overall survival, progression-free survival, and risk scores of the high-risk score group were worse than the low-risk group. The ROC curve analysis showed that the AUC values of the coagulation-related gene model at 1 year, 3 years, and 5 years were more than 0.65, validating the reliability of the prognostic model.

Conclusion: This study established the correlation between the coagulation-related gene model and glioma prognosis, providing deeper insight into the mechanism and treatment of glioma.

Aim: To compare T1-weighted contrast-enhanced (T1+C) with fast imaging employing steady-state acquisition (FIESTA) magnetic resonance imaging (MRI) sequences to protect healthy brain tissue during meningioma treatment with Gamma-Knife radiosurgery (GKRS).

Material and methods: After reviewing the data of 54 patients with solitary meningioma who underwent GKRS between January 2020 and June 2022, demographic characteristics were noted, tumor volumes on T1+C and FIESTA MRI sequences were measured, and sequences were compared. The patients were then divided into two groups according to the presence of invasion to intracranial venous sinuses (groups 1 and 2, respectively). SPSS 11.5 software was used for data analysis, with the level of significance set at 0.05.

Results: While no significant age and tumor size differences were observed between groups 1 and 2, sinus invasion was significantly higher among males. Tumor volumes measured in both groups were significantly smaller on FIESTA sequences than on T1+C sequences.

Conclusion: The T1+C sequence has been the primary imaging method because of meningiomas' high contrast enhancement feature. However, the T1+C sequence during GKRS planning is an effective imaging method in treating meningiomas; FIESTA sequences can more precisely delineate the tumor border. In this study, we consider that using the FIESTA/CISS sequence MRI for planning meningioma therapy with Gamma-Knife can reduce target volume and prevent irradiation of healthy brain tissue.

Definitive diagnoses in neuro-oncology often require invasive procedures, such as surgical biopsies to obtain tissue for histopathologic and molecular interrogation. Patients with small lesions that may respond to nonsurgical treatments, such as chemoradiation, may nevertheless undergo surgery with potential risks to obtain diagnostic tissue. A means for noninvasively obtaining diagnostic information from brain tumors may improve patient care by limiting the need for surgery. Molecular evaluation of exosomes may provide such a means. Exosomes are small vesicles excreted from tumor cells that contain molecular information. Isolation of these vesicles from peripheral fluids, such as blood and urine, may provide diagnostic information for rendering a definitive diagnosis. Here, we review current clinical data for exosome-mediated brain tumor diagnostics.

Aim: To evaluate the effects of tramadol on inflammation by measuring NLRP1 and IL-1 beta (IL-1β) levels in an experimental neuropathic pain model.

Material and methods: Sprague-Dawley rats were divided into three groups: control, chronic constriction injury (CCI), and CCI + tramadol. Neuropathic pain was assessed using mechanical allodynia, thermal hyperalgesia, and cold allodynia. IL-1β and NLRP1 levels were evaluated using ELISA on sciatic nerve (SN), dorsal root ganglion (DRG), and serum either on day 3 or days 8 postsurgery.

Results: On day 3, paw withdrawal latency (PWL) was lower in the CCI and CCI + tramadol groups than the control group in both mechanical and cold allodynia tests. On day 8, the PWL in the CCI group was also lower than in the control group. In contrast, tramadol increased the PWL on day 8 compared to day 3 in the CCI group. During cold allodynia, PWL decreased in the CCI group, however, tramadol reversed this effect on days 3 and 8. Tramadol, therefore, ameliorated pain hypersensitivity in mechanical/cold allodynia tests. Serum IL-1β levels were higher in the CCI + tramadol and CCI groups than the control group, although serum IL-1β levels in the CCI and CCI + tramadol groups were comparable. Tramadol decreased the IL-1β and NLRP1 in DRG compared with the CCI group. A similar trend was observed in the SN samples.

Conclusion: Our experiments revealed an increase in IL-1β and NLRP-1 levels in a neuropathic pain model and found that tramadol had an anti-inflammatory effect on the IL-1β and NLRP1 inflammasomes.

Aim: To investigate the efficacy of immunohistochemical methods to determine molecular subgroups and prognostic predictions of medulloblastomas (MBs).

Material and methods: β-catenin, GAB1, YAP1, filamin A and p53 were immunohistochemically stained, and MYC and MYCN fluorescent in situ hybridization (FISH) procedures were applied to 218 cases in our series.

Results: Based on the histomorphological characteristics of the cases, 67.9% were deemed classic MB; 15.6% as desmoplastic/ nodular medulloblastoma (DNMB); 12.8% as large cell/anaplastic (LC/A) MB; 3.7% as medulloblastoma with extensive nodularity (MBEN). Molecular characteristics revealed that 50.5% had non-WNT/non-SHH; 33.9% had SHH-activated and TP53-wildtype; 8.7% had WNT-activated; 6.9% had SHH-activated and TP53-mutant. According to the survival curves, LC/A MBs or non-WNT/ non-SHH tumors showed the worst prognosis, whereas DNMBs and WNT-activated tumors showed the best prognosis. Classic MBs or SHH-activated tumors showed a moderate course. MYCN amplification was found to act as an independent poor prognostic factor in the study.

Conclusion: The distribution of histological subtypes and molecular subgroups, amplification rates, and prognostic data obtained through immunohistochemical methods in our study were consistent with those reported in the literature. It was therefore hypothesized that the determination of molecular subgroups by immunohistochemical methods can be useful in daily diagnostic practice, especially in centers with limited access to molecular techniques.

Aim: To investigate the possible mediation of epigenetic mechanisms underlying the regenerative effect of uridine in a sciatic nerve transection rat model.

Material and methods: Fifty adult male rats were randomized to sham, control, and uridine groups. After unilateral transection and primary anastomosis of the right sciatic nerve, a single daily dose of saline (1 ml/kg; sham and control groups) or uridine (500 mg/kg; uridine group) was injected intraperitoneally for a week. The sciatic nerves were removed en bloc on the eighth day and levels of histone deacetylase 1 (HDAC1), acetylated histone-H3, and acetylated histone-H4 were analyzed in nerve homogenates. The number of myelinated axons in the sciatic nerve specimens was analyzed histomorphologically.

Results: The HDAC1 levels were significantly greater in the control group than in the sham (p < 0.001) and uridine (p < 0.01) groups. Compared to the sham group, the acetylated histone-H3 and histone-H4 levels decreased in the control group (by 81.49% and 79.98%, respectively for both; p < 0.001) and increased significantly in the uridine group (by 62.54% and 51.68% respectively; p < 0.01, p < 0.05). The number of myelinated axons decreased significantly (p < 0.001) in the control group, which was enhanced significantly by uridine administration.

Conclusion: Epigenetic mechanisms may partly mediate the regenerative effect of uridine treatment in a rat model of sciatic nerve injury. Our data provides novel insights in the management of peripheral nerve damage and suggests potential benefit of uridine for degenerative diseases in which epigenetic impairments are involved.

Aim: To determine the clinical relevance of a rigid endoscopy surgical method for subdural hematomas, as previously described in a cadaver study.

Material and methods: Between May 2021 and September 2023, 21 patients underwent subdural hematoma drainage using a 0-degree rigid endoscope. Traumatic acute subdural hematomas were excluded. The demographic data of the patients, antiplatelet/ antiaggregant use, perioperative findings, and pre- and post-surgery modified Rankin Scale (mRS) scores were recorded and analyzed.

Results: The mean age of our cohort was 65.63 (±20.52), and the male/ female ratio was 3.2: 1. The hematoma was unilateral in 90.5% of the patients, and the rate of trauma history was 42.9%. The most common radiological diagnosis was chronic subdural hematoma with septa (61.9%). The percentage of patients with a history of antiplatelet/ antiaggregant therapy was 23.8%. No mortality related to the surgery was observed in the early postoperative period; however, two patients underwent reoperation for further bleeding. The neurological grade was the only preoperative factor that had a statistically significant effect on the mRS score at discharge, with significantly better discharge mRS scores in grade 1 and 2 patients (p=0.014).

Conclusion: The procedure was found to be safe and feasible, with surgery-related morbidity and mortality within acceptable limits.

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.