Turkish neurosurgery最新文献

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.

Aim: To develop a nomogram model that provides a clinical prediction method for preventing septated chronic subdural hematoma (sCSDH) recurrence after surgery and serves as a reference for selecting surgical approaches.

Material and methods: This study involved 237 patients diagnosed with sCSDH. Based on the recurrence status of the affected side during follow-up, patients were divided into a recurrence group (43 cases) and a non-recurrence group (194 cases). The imaging-related factors influencing the recurrence of sCSDH after surgery were initially screened using univariate analysis, followed by multivariate logistic regression analysis to identify independent risk factors. A nomogram model was developed using R software, and internal validation was conducted using the bootstrap method.

Results: The univariate analysis revealed that cerebral atrophy, bilateral hematomas, preoperative midline shift distance, sCSDH typing, and neovascularization were the significant factors in the postoperative recurrence of sCSDH. However, the multivariate logistic regression analysis identified encephalatrophy, bilateral hematomas, and neovascularization as independent risk factors for sCSDH recurrence. Furthermore, the nomogram model analysis demonstrated good discrimination with an AUC of 0.764 (95% CI: 0.6958-0.8322), while the P-value of the Hosmer-Lemeshow test was 0.4382, indicating good consistency.

Conclusion: Encephalatrophy, bilateral hematomas, and neovascularization are independent imaging risk factors associated with sCSDH recurrence. The developed nomogram model will enable clinicians to assess and identify patients at a higher risk of sCSDH recurrence, enabling them to formulate appropriate diagnostic and treatment strategies.

Aim: To evaluate the adherence to and awareness of current concussion/mild traumatic brain injury (mTBI) guidelines among Turkish neurosurgeons.

Material and methods: A cross-sectional electronic survey was administered to all members of the Turkish Neurosurgical Society (n=1875 neurosurgeons) between January and February 2024. The 208 respondents (11.1%) were categorized based on years of neurosurgery specialization, type of current institution, residency program accreditation, and current institution accreditation.

Results: The majority of the participants (66.3%) were employed in Tertiary-level Healthcare (TLH) institutions. In TLH settings, Emergency Medicine Practitioners (EMPs) were primarily responsible for the initial computed tomography (CT) scan for pediatric patients, while this decision was also made by EMPs for adult patients, regardless of years of experience in neurosurgery specialization. Participants enrolled in residencies at accredited institutions were more likely to obtain detailed patient histories. The rates of adherence to current guidelines were comparable across institutions, regardless of their accreditation status.

Conclusion: This pioneering study evaluating neurosurgeons? adherence to and awareness of concussion/mTBI guidelines revealed a uniformity in compliance among Turkish practitioners, irrespective of years of experience, institutional type, or accreditation status.

Aim: To systematically review the existing literature on the neurotoxic effects of microplastics (MPs) on the brain.

Material and methods: This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta- Analyses guidelines. The following keywords were used for the literature search ?microplastics? and ?human brain? in PubMed and ?microplastics,? ?health,? and ?neurotoxicity? in Web of Science. Risk of bias was assessed using the Revised Risk of Bias Tool for Randomized Trials.

Results: We identified 72 records from the databases and 12 records from the citation search. After exclusion, 11 records were included in this review, which revealed various effects of MPs on the human body at the molecular, cellular, and clinical levels. We observed that oxidative stress and energy disruption are the main toxic effects of MPs; in addition, they can induce neuroinflammation, alter biochemical pathways such as amino acids and neurotransmission, and cause cell death.

Conclusion: MPs are a significant global health problem. With the widespread use and accumulation of plastic materials, MPs can reach the nervous system and exert neurotoxic effects manifesting in behavioral and cognitive changes. The current evidence is insufficient to delineate the possible long-term outcomes of MP exposure. Further clinical studies are warranted to elucidate the mechanisms underlying these neurotoxic effects.

Penetrating brain injuries are usually the result of high-velocity accidents. However, intracranial foreign bodies can also rarely occur as a result of child abuse. Inserting a sewing needle into the brain through the sutures before the closure of fontanelles represents a particularly intriguing and relatively unknown form of attempted infanticide. In this study, we analyzed two adults who presented with an intracranial foreign body. Case 1: A 36-year-old woman presented with complaints of headache. Radiographic evaluation revealed a sewing needle lodged in her brain. Case 2: A 62-year-old man was admitted with seizures. Radiographic examination revealed three sewing needles in his brain. Both patients were managed conservatively due to the non-threatening nature of their symptoms. Several victims of needle insertion incidents go unreported. Survivors of such incidents may present with late complications. The needle is often incidentally detected during adulthood. A limited number of publications indicate that authors tend to refrain from treating asymptomatic patients. Furthermore, the related ethical concerns pose significant challenges for the physicians.

Aim: To assess the clinicopathological and prognostic significance of Tim-3, an immune checkpoint molecule, and Rel-B, an NF-?B subunit, in grade 4 diffuse glioma samples and their relationship with each other.

Material and methods: The demographic, radiologic, treatment, and prognostic data of patients diagnosed with grade 4 diffuse glioma between 2016 and 2019 were reviewed and recorded. Tim-3 and Rel-B were applied to the paraffin-embedded tissues by immunohistochemistry method. Tim-3 expression was grouped as immunoreactivity density score (IDS) (Low, High) and expression percentage ( < 12%, > 12%), while Rel-B expression was divided into positive and negative groups.

Results: Ninety-nine grade 4 diffuse glioma samples were detected, 8 of which were IDH-1 positive. Tim-3 was expressed only in immune cells around and inside the tumoral tissue, and expression was detected only in tumoral cells with Rel-B. Tim-3 IDS was found at lower levels (median 31.8) in IDH-1 positive cases and higher (median 158) in IDH-1 negative ones (p=0.020). A significant correlation was found between the Tim-3 IDS high group and Rel-B positivity (p=0.007). In the IDH-1 negative cohort, the univariate analysis revealed higher Tim-3 expression percentage and higher IDS were associated with better overall survival (OS) (p=0.041 and p=0.042 respectively) and progression-free survival (PFS) (p=0.023 and p=0.029 respectively), while in the multivariate analysis higher Tim-3 expression percentage was found to be an independent predictor for better OS (p=0.008) and PFS (p=0.022). Rel-B positive cases exhibited longer OS and PFS but the result was not statistically significant (p > 0.05).

Conclusion: Tim-3 can be a good prognostic predictor and treatment candidate, especially in patients with IDH-1 negative grade 4 diffuse gliomas however, further studies with more cases are needed for Rel-B. The significant relationship between Tim-3 and Rel-B expressions supported the interaction between NF-?B and immune checkpoint pathways.

Aim: To analyze the epidemiologic, clinical, neuroradiological, and histopathological data of patients who have undergone anterior temporal lobectomy (ATL) for drug-resistant mesial temporal lobe epilepsy (MTLE).

Material and methods: The study included patients who were diagnosed with MTLE refractory to medical treatment, underwent anterior temporal lobectomy at our institution between 2010 and 2020 and had postoperative clinical follow-up data. The epidemiologic, clinical, neuroradiological, and histopathological data of the patients were collected.

Results: Fourteen patients were male, and thirty were female. The mean age at seizure onset was 15.3 years. Video electroencephalographic monitoring (VEM), magnetic resonance imaging (MRI), and positron emission tomography (PET) revealed lateralization in 37, 36, and 31 patients, respectively. The cranial MRI and PET were inconclusive in eight patients in whom the diagnosis was verified via invasive monitoring. Thirty-six (81.8%) patients were seizure-free postoperatively. The number and dosage of antiepileptic drugs used were reduced in 35 (79.5%) and 26 (78.8%) patients, respectively. Only six patients developed complications (cerebrospinal fluid fistula, n = 3; central nervous system infection, n = 2; and epidural hematoma, n = 1).

Conclusion: Epilepsy is a significant cause of morbidity for patients, and surgery plays a vital role in treating mesial temporal sclerosis, an etiology of epilepsy. Patients can be diagnosed using various tests such as cranial MRI, electroencephalography, VEM, PET, single-photon emission computerized tomography, neuropsychological tests, and invasive monitoring at advanced epilepsy centers. Surgical treatment is highly effective and safe in these patients.

Aim: To examine the risk factors for postoperative C5 palsy, particularly an association between the laminectomy width and C5 palsy after open-door cervical laminoplasty (CLP).

Material and methods: This single-center study analyzed data from 132 adult patients who underwent open-door CLP for degenerative diseases. C5 palsy developed in 8 (6.1%) patients, although seven of them made a full recovery. The demographic and radiographic findings of the C5 palsy group were compared with those of the non-C5 palsy group.

Results: The laminectomy width did not correlate with the incidence of C5 palsy (C5 palsy group, 19.39 ± 1.86 mm; non-C5 palsy group, 20.77 ± 2.61 mm, p > 0.05). The preoperative T2-high lesion in the spinal cord on magnetic resonance imaging was present in 62.5% of the patients in the C5 palsy group, whereas it was positive in 20.3% in the non-C5 palsy group (p = 0.021). The mean C4/5 foraminal minimal distances on the open side were 2.42 and 3.58 mm in the C5 and non-C5 palsy groups, respectively (p = 0.001). These variables might be risk factors for C5 palsy.

Conclusion: The laminectomy width was not associated with the incidence of C5 palsy. The risk factors for C5 palsy were the preoperative T2-high lesion in the spinal cord and C4/5 foraminal stenosis on the open side after open-door CLP.

Erdheim-Chester Disease is a rare systemic xanthogranulomatous infiltrating disease, characterized by lipid-laden histiocytes accumulating in various organs and almost always in bones. Etiology of the disease is still unknown. It may involve various organs and systems, such as musculoskeletal, cardiac, pulmonary, renal, gastrointestinal and central nervous system (CNS) as well as the skin. The most common systemic manifestations are bone lesions and the specific sign of these are bilateral sclerosis of the diaphysis and metaphysis of long bones. Symptoms and signs can vary related to the organ or system that is involved. In CNS involvement, cerebellar and pyramidal symptoms and signs are the most common, while headache, seizure, cranial nerve paralysis, neuropsychiatric along with cognitive complaints and mood disorders are also reported. Furthermore, there are asymptomatic cases. Histologically lipid-laden foamy histiocytes with small round nucleuses and without nuclear grooves are the characteristic histological features. These histiocytes show positive CD68 and negative S100 and CD1a immunoreaction. Surgery is a reasonable treatment in the patients who have extra- or intracranial lesions with smooth borders when the neurological signs and symptoms are mild. Medical treatment of the disease includes steroid, cytotoxic agents such as cladribin, IFN α-2a, recombinant human interleukin-1 receptor antagonist, tirosine kinase inhibitors, biphosphonate and autologue hematopoetic stem cell transplantation. In this report a 29 years old man was presented with a frontal calvarial lesion who was operated and diagnosed as Erdheim Chester disease.

Aim: To illustrate the middle cranial fossa (MCF) approach to the pterygopalatine fossa (PPF), infratemporal fossa (ITF), and parapharyngeal space (PPS) with temporomandibular joint (TMJ) preservation through step-by-step cadaver dissection and discuss certain critical considerations that are inadequately addressed in the literature.

Material and methods: Six sides of three formalin-fixed, latex-injected specimens were dissected under an operating microscope to illustrate this unique approach. All steps were documented.

Results: The MCF approach with TMJ preservation provides excellent access to the PPF and ITF, and limited exposure of the PPS. Key steps include positioning and craniotomy, lateral loop drilling, MCF removal, PPF dissection, ITF dissection, maxillary artery dissection, and PPS dissection.

Conclusion: The MCF is a promising corridor for accessing these complex exocranial skull base areas. Although live surgery may be quite different from cadaver dissection, every surgeon must master the relevant anatomy before entering the operation theatre.