Turkish neurosurgery最新文献

Aim: To investigate the incidence of transverse carpal muscle (TCM) occurrence around carpal tunnel which may lead to carpal tunnel syndrome (CTS), and cause disorientation of surgeons during the surgery.

Material and methods: We reviewed patients in our department between January 2007 and March 2021 to identify those who underwent surgical treatment for CTS. A total of 62 carpal tunnel release surgeries were investigated, and the frequency of TCM occurrence was evaluated.

Results: There were 3 (4.8%) accessory TCM overlying transverse carpal ligament (TCL). All variations occurred in the left hand of the patients. Of the three cases, two were female and one was male.

Conclusion: There is currently insufficient evidence in the literature to suggest that TCM is causing CTS. To further investigate the origin of these muscles, cadaveric dissections should be performed. Even if this variation isn?t causing CTS, especially during minimal invasive surgeries, this variation should be kept in mind to not lose orientation.

Trigeminal schwannomas are rare lesions centered on the trigeminal ganglion at Meckel?s cave. The complexity and morbidity of surgery for these lesions have allowed stereotactic radiosurgery (SRS) to emerge as a safe and viable option for treatment. Various other lesions at this location must alert one to consider an alternative diagnosis before upfront SRS without histopathological correlation. We present three patients with trigeminal neuropathy with imaging suggesting trigeminal schwannoma. Primary clinicians recommended primary radiosurgery to these patients based on radiological diagnosis. Upon further evaluation and clinical suspicion, we established alternate diagnoses of non-Hodgkin's lymphoma, lepromatous trigeminal nerve involvement, and Aspergillosis involving the Meckel's cave in three cases. Each patient received appropriate treatment instead of SRS. SRS is one of the treatment options for trigeminal schwannomas. No neurosurgical ailment should be treated on its face value with primary SRS, but it must be carefully evaluated on a clinicoradiological profile. Upfront, primary SRS may be counterproductive or detrimental for inflammatory or infectious pathologies, attracting complications.

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.

Aim: To examine the genetic results of patients diagnosed with pituitary neuroendocrine tumors (PitNETs) with respect to clinical, radiological, and pathological findings.

Material and methods: A total of 53 patients (30 men and 23 women) diagnosed with PitNETs were included in the study. The clinical findings, family history, imaging, and pathology results were recorded. The DNA was isolated from the peripheral blood. A customized panel test with the highest number of genes (28 genes associated with PitNET) found in the literature was used. Sequencing was conducted using the next-generation sequencing method, and the variants were analyzed according to current guidelines.

Results: A total of 22 variants were identified in 20 patients, two of which were determined to be pathogenic. Pathogenic variants were detected in AIP (c.468+1G > A) and MEN1 (c.1102_1104del) genes, which showed the most common pathogenic variant. Variants of unknown clinical significance were most frequently detected in the MSH6, RET, and CDH23 genes.

Conclusion: Although the number of studies that conducted multigene testing in patients with PitNETs is limited, all studies, including ours, have shown that the patient?s age at diagnosis and family history are the most important determinants of germline variant detection.

Aim: To explore the risk factors associated with the occurrence of lower extremity deep vein thrombosis (DVT) after craniotomy in patients with primary brain tumors, and to develop a predictive model using machine learning.

Material and methods: A prospective cohort study was conducted on 140 patients with primary brain tumors who underwent neurosurgical treatment at our hospital between March 2021 and September 2022. A logistic regression analysis was performed to identify independent risk factors associated with postoperative DVT. Additionally, multiple machine learning models were developed and evaluated to determine their predictive performance.

Results: The incidence of lower extremity DVT after craniotomy was 27.9%. Logistic regression identified age [OR=1.07, 95% CI (1.03-1.11)], GCS score [OR=0.88, 95% CI (0.78-0.98)], D-dimer level [OR=1.08, 95% CI (1.02-1.15)], and mechanical ventilation (≥48 hours) [OR=3.83, 95% CI (1.21-12.15)] as independent risk factors (P < 0.05). The Gradient Boosting Machine (GBM) had the highest prediction accuracy among the assessed machine learning models, achieving an area under the curve (AUC) of 0.850, with a sensitivity of 56.44% and a specificity of 90.09%.

Conclusion: Age, D-dimer, and mechanical ventilation (≥48 hours) are independent risk factors for the development of lower extremity DVT after craniotomy in patients with primary brain tumors. The GCS score serves as a potential protective risk factor. The GBM model, with its high AUC and specificity, offers a promising tool for early identification of high-risk patients, potentially informing clinical decision-making and targeted interventions.

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.

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.