Turkish neurosurgery最新文献

Aim: To compare the overall survival (OS), progression-free survival (PFS), and the impact of prognostic markers in unifocal and multifocal IDH wild-type glioblastomas (GBMs).

Material and methods: This retrospective single-institutional study involved 177 GBM patients diagnosed between 2015 and 2022. Patients with confirmed IDH wild-type GBM were selected to assess the impact of lesion focalities on prognosis. Surgical procedures included gross total resection (GTR), subtotal resection (STR) or biopsy. Radiation therapy (RT) employed the intensitymodulated (IM)RT technique, combined with concurrent temozolomide (TMZ) treatment. Survival analyses and prognostic factors were performed accordingly.

Results: We examined 101 IDH wild-type glioblastoma patients, of whom 78 had unifocal and 23 had multifocal tumors. The median patient age was 60 years, comprising 37% females and 63% males. Surgical approaches included GTR (13%), STR (53%), and biopsy (34%). Positive p53 expression was seen in 65 patients. All patients received TMZ with RT. Adjuvant therapy referral was arranged for 68 patients. Progression occurred in 49% (38 unifocal, 11 multifocal cases). PFS analysis showed no significant difference between unifocal and multifocal patients. OS analysis also showed no significant difference. Univariate analysis revealed PFS factors: focalization, p53 expression, hypofractionated RT. For OS, adjuvant TMZ usage was influential. Extent of resection impacted OS-STR had 3.47-fold higher risk than GTR.

Conclusion: This study sheds light on the management of multifocal glioblastoma, providing insights into treatment strategies and survival outcomes. Despite challenges, optimal management approaches are crucial for improving patient prognosis and quality of life.

Aim: To determine if previous histological grading systems were sufficient or unreliable with a limited repository of modern techniques.

Material and methods: The pathology reports of pediatric neurosurgery patients between 2019-2022 were accessed. Data on patients that needed unattainable further molecular investigation were extracted. Data were noted from electronic archives, including their sex, age, histologic grade, location, resection type, survival, and therapy.

Results: Out of 61 surgeries, 17 patients needed further investigation for a proper 2022 World Health Organization (WHO) diagnosis. Seven were deceased, and nine were alive. Two of 10 patients with low-grade gliomas and five of six patients with highgrade gliomas were deceased. Data on one foreign patient with high-grade glioma was inaccessible. The average survival was 9 months for the deceased.

Conclusion: Modern molecular techniques such as next-generation sequencing and methylation profiling are the state-ofthe- art methods, but it is hard for developing and underdeveloped countries to utilize such methods. The classification schemes, diagnostic key figures, and treatment modalities are developed using these techniques, but the less developed world is incapable of achieving these. We are trying to hybridize the modern and classic modalities, and the results of our study show that for overall survival, there is still not much difference. More economic and feasible techniques should be produced and summarized for the rest of the world.

Aim: To investigate the possible association between COVID-19 infection and intraparenchymal hemorrhage (IPH) by examining changes in the preoperative and postoperative periods, mortality, and the impact of COVID-19 on IPH survival times.

Material and methods: This cross-sectional retrospective analysis included 82 IPH cases operated on and treated between January 2021 and March 2023. Brain computed tomography/magnetic resonance imaging scans were used to confirm the diagnosis of IPH and provide evidence of neurological damage. The information was gathered using a predesigned form of hospital records. Participants were included if they had a positive COVID-19 result or displayed no symptoms, indicating a past infection.

Results: The study included 82 people, nine (11%) of who tested positive for COVID-19 and 73 (89%) tested negative. There was no difference in mortality rates between the two groups (p=0.651). The hematoma volume decreased from the preoperative (82.4 ± 42.4) to the postoperative (23.7 ± 44.8) measurement (p < 0.001). The midline shift value decreased from the preoperative (9.26 ± 4.71) to the postoperative (5.16 ± 5.06) assessment (p < 0.001). Patients without COVID-19 infection had a mean survival time of 31.5 days and a median survival time of 23 days, whereas patients with COVID-19 infection had a survival time of 25.7 days and a median survival time of 8 days.

Conclusion: Our findings show that hematoma volume and midline shift improve significantly after surgery, although GCS scores remain unaltered. Except for AST and ALT levels, there were no significant differences in mortality rates, demographic, clinical, and most laboratory results between COVID-19-positive and COVID-19-negative patients.

Aim: To investigate the impact of obesity on postoperative morbidity and mortality in patients who underwent anterior cervical discectomy and fusion (ACDF).

Material and methods: The American College of Surgeons' National Surgical Quality Improvement Project (NSQIP) files from 2006 to 2019 were queried for all patients who underwent an ACDF. Fisher exact tests were used in analyzing univariate differences in preoperative comorbidities and postoperative morbidity and mortality between patients with and without obesity (BMI ?30 kg/ m < sup > 2 < /sup > ). Results with a p value < 0.05 were considered statistically significant. Multivariable logistic regression models were used in determining the independent impact of obesity on ACDF postoperative morbidity and mortality. A p value < 0.017 was required for multivariate statistical significance.

Results: There were 96,882 patients who underwent an ACDF from 2006 to 2019 found. 53.77% had non-obese BMI. Patients had statistically significant differences in most perioperative comorbidities and postoperative outcomes on univariate analysis. On multivariate analysis, patients with obesity has decreased adjusted odds of wound infections (aOR=0.7208, CI 0.574-0.9075, p=0.0053), pulmonary events (aOR=0.7939, CI 0.6903-0.9129, p=0.0012), sepsis (aOR=0.5670, CI 0.4359-0.7374, p=2.32E-05), transfusion requirements (aOR=0.5396, CI 0.4498-0.6473, p=3.04E-11), return to operating room (aOR=0.7537, CI 0.6727-0.8447, p=1.17E-06), and length of stay > 10 days (aOR=0.7061, CI 0.6438-0.7744, p=1.49E-13).

Conclusion: Obesity is a protective factor toward ACDF postoperative complications. Obesity as a marker of patient selection criteria for ACDF procedures should not be used by spine surgeons.

Aim: To review the cases of craniosynostosis secondary to ventricular shunting procedure.

Material and methods: We retrospectively evaluated the medical records of all pediatric patients with hydrocephalus who were treated with ventriculoperitoneal shunt procedure between the years 2017 and 2021 at the Selcuk University, Ankara University, and Bursa Uludag University.

Results: Twenty-one patients were included in the study. The median age at the time of insertion of ventriculoperitoneal shunt for hydrocephalus was 8.1 (range, 1?22) months. Seven patients were shunted because of congenital hydrocephalus. The mean time to development of secondary synostosis was 8.8 (range, 1?36) months. Plagiocephaly was the most common type of secondary synostosis. While shunt revision was performed in 16 patients, cranial vault expansion surgery was performed in 5 patients.

Conclusion: Slit ventricle syndrome is a frequent condition at shunted patients, but there is no consensus on identifying patients who require treatment. Using programmable or high-pressure valves, performing cranial vault modeling are possible treatment modalities. Increased awareness of this condition in follow-up may allow early diagnosis and intervention and prevent it from evolving into more serious deformities.

Aim: To investigate the relationship between epidural contrast spread patterns, and the treatment success of cervical interlaminar epidural steroid injection (CIESI) for cervical radicular pain.

Material and methods: A total of 76 patients aged between 20 and 60 years who had neck and unilateral upper limb pain due to a single-level disc herniation at C5-C6 or C6-C7 were included. Severity of pain and disability were assessed with Numerical Rating Scale (NRS-11) and Neck Pain Disability Scale (NPDS) at baseline, three weeks, and three months after the treatment. Contrast dispersion prior to injection of the medication was graded in anteroposterior fluoroscopic view. Treatment success was defined as a ≥50% improvement at three months in the NRS-11 scores compared to baseline.

Results: A significant improvement in pain and disability scores was observed at three months compared to baseline (p < 0.001). Treatment success was observed in 57% of the patients. The multivariate binary logistic regression analysis revealed that high initial NPDS scores, severe foraminal and central stenosis, Grade 1 contrast spread pattern were negative predictors of response to CIESI.

Conclusion: Lateral contrast spread toward the dorsal root ganglion (DRG) and spinal nerve root of the target level was associated with more favorable clinical responses. Clinicians performing CIESIs should exert effort to administer the injectate around the DRG and spinal nerve root at the target level.

Aim: To examine the role and mechanism of colorectal tumor differential expression (CRNDE) in brain injury induced by ischemicreperfusion.

Material and methods: Sh-SY5Y cells were cultured, and oxygen and glucose deprivation/reperfusion (OGD/R) injury tests were performed. The effects on SH-SY5Y cells were evaluated by the Cell Counting Kit-8 (CCK-8) assay, qPCR, apoptosis analysis, western blot analysis, ELISA, a luciferase reporter assay, and an RNA pull-down assay.

Results: Knockdown of CRBDE ameliorated SH-SY5Y cell impairment induced by OGD/R. CRNDE, the target of mir-489-3p, was directly bound to FOXO3. Mir-489-3p knockdown partially reversed OGD/R-mediated impairment in CRBDE knockdown SH-SY5Y cells.

Conclusion: The results indicate that knockdown of lncRNA CRNDE ameliorates apoptosis and the inflammatory response in ischemia-reperfusion-induced brain injury through the mir-489-3p/FOXO3 axis. LncRNA CRNDE may represent a novel therapeutic target for brain injury.

Aim: To evaluate the effect of intensive care follow-up and treatment methods on the prognosis of 28 patients admitted to the pediatric intensive care unit (PICU) due to stroke.

Material and methods: The data of patients aged between 28 days and 18 years followed up between 2011 and 2021 were recorded retrospectively.

Results: Thirteen (48.1%) patients were diagnosed with hemorrhagic stroke (HS), 11 (40.7%) patients were diagnosed with acute ischemic stroke (AIS), and three (11.1%) patients were diagnosed with cerebral sinus vein thrombosis. One patient was followed up for non-ruptured arteriovenous malformation (AVM) and was excluded from the HS group. The HS group consisted of eight patients with ruptured AVMs and five patients with ruptured intracranial aneurysms. The patients had male predominance, and seizures and headache were the most common complaints on admission. The rate of admissions due to seizures was higher in the AIS group. In the HS group, there was more involvement of the right side of the brain. Middle cerebral artery (MCA) involvement was higher in the AIS group. The AIS group had longer PICU hospitalization days and mechanical ventilator days. While unfractionated heparin was preferred for the treatment in the AIS group, endovascular embolization was preferred in the HS group. Decompressive surgery was performed in five patients. The overall mortality rate was 7.1%.

Conclusion: Although cerebrovascular events are rare in the pediatric population, achieving low mortality and morbidity is possible with the correct diagnostic and treatment methods.

Aim: To examine the outcomes of microsurgery only versus combined microsurgery and embolization in treating cerebral arteriovenous malformations (AVM).

Material and methods: A total of 62 patients (34 male and 28 female) with Spetzler-Martin grade 3 (n=44) and grade 4 (n=18) AVMs were examined. Thirty-seven patients were treated with a combination of microsurgery + embolization, whereas 25 patients were treated with microsurgery alone. The clinical characteristics of the treatment groups were compared (ruptured/unruptured, eloquent/non-eloquent, modified Rankin scores, duration of surgery, preoperative and postoperative hemoglobin levels, and use of blood products).

Results: The number of patients with ruptured or eloquently localized AVMs was more in combination of microsurgery + embolization. On the other hand, the duration, preoperative versus postoperative hemoglobin levels, and usage of blood products did not differ between treatment groups.

Conclusion: The results of the study showed no superiority of the combined treatment in managing AVMs in parallel to recent meta-analyses. However, a patient-tailored approach is recommended while making the treatment decision for such challenging intracerebral AVM cases.

Aim: To assess the combined antitumor potential of theranekron (Trn) and cisplatin in neuroblastoma (NB), a pediatric tumor characterized by high prevalence and mortality rates. The investigation involved examining the interaction between theranekron (10-100 ?M) and cisplatin (40 ?M) within this cell line.

Material and methods: The cytotoxicity of Trn was evaluated using MTT assays, cell volume analyses, apoptosis assessments, and measurements of mitochondrial membrane potential. These evaluations were conducted over a 24-hour incubation period.

Results: The coadministration of 100 µM Trn with cisplatin exhibited a cytotoxic effect of approximately 60%. Furthermore, it led to a reduction of up to 38% in cell volume. Notably, SH-SY5Y cells demonstrated an early apoptosis rate of 34.4%, accompanied by an eightfold decrease in mitochondrial membrane potential compared to the control group.

Conclusion: Trn demonstrated synergism and significantly enhanced the efficacy of cisplatin (p < 0.001). Nevertheless, further in-depth investigations are necessary to elucidate the intricacies of these synergistic effects.