Turkish neurosurgery最新文献

Aim: To evaluate the effect of single and double anterior odontoid screw fixation on the ROM of the craniocervical area and the stress distribution on the implants in a Finite Element Analysis which may give us ideas about the possible results for IF and malunion.

Material and methods: A FE model of the craniocervical area was constructed and a type II fracture model was created. In model A, a single screw and in model B two screws were used to fixate the model. The ROM and von Misses stress distribution on implants was evaluated.

Results: The ROM values of the models with fixation closely resembled those of the intact model, showing less than a 10% difference in ROM. Under loading conditions in flexion, extension, rotation and lateral bending directions for each model, both structures exhibited similar stress distributions. In both models, the stress was distributed throughout the whole shaft, whereas during lateral bending and rotation, the stress was localized more on the distal part. But the maximum stress on implants were higher in the single screw model.

Conclusion: We believe that double odontoid screws decrease the stress on implants, thus decreasing the risk of IF without significantly affecting ROM.

Aim: To determine sac volume based on radiological examinations in patients undergoing surgery for myelomeningocele (MMC) and to investigate the relationship of sac volume with hydrocephalus and Chiari malformation type 2 (CM) with a view to determining the optimum length of follow-up and recommend a treatment plan.

Material and methods: The present study involved the retrospective review of radiologic examinations and medical files of 81 patients who underwent surgery for myelomeningocele between 2015 and 2022 in the neurosurgery clinic of Ankara Training and Research Hospital. Then, MMC sac volumes were measured and the statistical relationship of these measurements with the Evans Index, progressive enlargement of the ventricles after sac repair and CM was investigated.

Results: Of the 81 patients, 41 (50.6%) were boys and 40 (49.4%) were girls. The median MMC sac volume was 11,005.28 mm³ and the mean Evans index (EI) based on brain tomography performed on postnatal day1was 0.405 ± 0.146. Analysis of the relationship between the EI and MMC sac volume yielded r=0.622, p < 0.001 and showed a strong positive correlation between the two parameters at a statistical significance level of 5%. Evans Indexes based on brain tomography scans performed on postnatal day 1 showed that ventriculomegaly was present in 49 (60.5%) patients and absent in 32 (39.5%) patients. In patients who developed hydrocephalus after sac repair, there was no correlation between the day of intervention and sac volume. Mean sac volume was 28,297.36 mm³ in 28 patients with comorbid CM versus 7,600.32 mm³ in patients without CM. All children with CM required shunting.

Conclusion: Patients with larger myelomeningocele sac volume have higher risk of concomitant hydrocephalus or subsequent development of hydrocephalus after sac repair compared to patients with a smaller sac volume. These patients should definitely be evaluated for same-session intervention. Patients with a larger sac volume and/or comorbid CM should be followed up more frequently and for a longer period of time.

Aim: To evaluate the postoperative magnetic resonance imaging (MRI) findings and clinical outcomes of patients who underwent monoportal endoscopic lumbar discectomy.

Material and methods: Preoperative and postoperative 3rd and 6th month MRI features, visual analog scale (VAS), and Oswestry Disability Index (ODI) scores, as well as other clinical features of patients who underwent monoportal endoscopic lumbar discectomy between August 2009 and January 2012 were retrospectively analyzed.

Results: A total of 65 patients (37 female, 28 male) were included in the study. VAS and ODI scores showed significant improvement postoperatively (p < 0.001). Intervertebral disc height loss was observed only in two patients. In 31 (48%) of the 64 levels treated, no significant anterior soft tissue mass developed. However, 33 patients (52%) showed anterior epidural edema and tissue formation postoperatively. Contrast enhancement of the nerve root was found in 20 levels (29.4%), nerve root edema in 3 levels (4.41%), and nerve root displacement in 3 levels (4.41%). None of the patients had all 3 aforementioned findings concomitantly. Of the 57 levels evaluated, 36 levels (63%) showed no or minimal changes in the posterior elements, and at the 3rd month, 9 levels (15.8%) demonstrated grade 1+ changes, 9 levels showed grade 2+ changes, and grade 3+ changes were seen in only 3 levels; however, at 6-month follow-up, all vertebral levels showed improvements.

Conclusion: Endoscopic discectomy is a safe and effective minimally-invasive method. However, owing to the lack of definitive radiological criteria indicating success or failure, the radiological findings should always be interpreted in conjunction with clinical outcomes.

Aim: To investigate the effect of obesity on the severity of cerebral vasospasm after subarachnoid hemorrhage.

Material and methods: In this study, six experimental groups, each consisting of 10 rats, were defined (60 rats in total). Groups 1 and 2 comprised rats with normal body weight, Groups 3 and 4 comprised obese rats, and Groups 5 and 6 comprised rats that returned to normal body weight after being obese. Rats in Groups 2, 4, and 6, represented the study groups, and experimental SAH was induced in them. Group 1, 3 and 5 was determined as the control group. Basilar artery lumen areas and wall thicknesses were measured and compared in all groups.

Results: The luminal area of the basilar artery was significantly reduced in Groups 2, 4, and 6, than in Groups 1, 3, and 5, respectively. This indicated the development of vasospasm. No significant differences were found in the basilar artery luminal areas and wall thicknesses between Groups 1, 3, and 5. However, there were significant differences between Groups 2, 4, and 6. The basilar artery luminal area was significantly smaller in Group 4 than in Groups 2 and 6. There was no significant difference in basilar artery luminal areas between Groups 2 and 6.

Conclusion: This experimental study elucidated that the severity of vasospasm subsequent to subarachnoid hemorrhage escalated in the presence of obesity, and conversely, a return to normal body weight mitigated the severity of cerebral vasospasm. Prospective clinical investigations ought to scrutinize the correlation between obesity and vasospasm, emphasizing the necessity for vigilant monitoring of vasospasm post-SAH in obese patients.

Aim: To examine the effects of phenolic compound-rich ginger extract on motor and cognitive functions as well as cytokine levels in the mild traumatic brain injury (mTBI) model.

Material and methods: The mTBI model was modeled employing the Marmarou method. The Ginger group rats were i.p. administered 50 mg/kg of ginger extract. The Ginger+traumatic brain injury (TBI) group rats were i.p. administered 50 mg/kg of ginger extract two days before the TBI was induced. The control and TBI+Ginger group rats were provided ginger extract (50 mg/ kg i.p.) immediately after the TBI. Motor and cognitive behavioral experiments were performed. The cytokine levels were analyzed using the ELISA method.

Results: While TBI caused a decline in motor and cognitive functions, significant enhancements of these functions were observed in the Ginger+TBI and TBI+Ginger groups because of the ginger treatment. While TBI induced an increased hippocampal cytokine level, significant decreases were detected in the Ginger+TBI and TBI+Ginger groups following ginger treatment.

Conclusion: The study findings revealed that phenolic compound-rich ginger extract may exert therapeutic effects on cytokine levels in the mTBI model.

Aim: To report a single center experience in preoperative stereotactic radiosurgery (SRS) in patients with metastatic brain tumors.

Material and methods: We identified 18 patients who underwent preoperative stereotactic radiosurgery (SRS) in our clinic between 2015 and 2021. Two patients were lost to follow-up and therefore were excluded from clinical outcome analyses. SRS was administered using the CyberKnife system.

Results: The median volume of index lesion was 14,19 mL (range 3,13-40,84). SRS was performed in median 1 fraction (range 1-2) to a median prescription dose of 15 Gy (range 12-17). Gross total resection was achieved in 14 (77.8%) patients. The median follow-up was 15 months (range 1-87). Median cancer specific survival (CSS) was 31 months. 6-, 12- and 24- months local control (LC) rates were 91%, 79% and 68%, respectively. Better gross tumor volume coverage was associated with better LC (p=0.01). 6-, 12- and 24- months distant brain control (DBC) rates were 82%, 58% and 47%, respectively. The infratentorial location of index lesion was associated with worse DBC (p=0.026). None of the failures were in the pattern of leptomeningeal dissemination (LMD). Grade IV symptomatic radionecrosis (RN) was reported in a single case. Three patients experienced fatal (grade V) post-operative complications.

Conclusion: Preoperative SRS approach, which provides the advantage of low rates of RN and LMD, is a meritorious alternative strategy in the treatment of brain metastasis. Care must be given to better assessment of surgical mortality and the selection of appropriate patients for this treatment approach.

Aim: To evaluate the radiological characteristics, clinical features,and surgical outcomes of bicoronal incision and bifrontal craniotomy for olfactory groove meningiomas (OGMs).

Material and methods: This was a retrospective review of 16 patients (nine male and seven female) with large and giant OGMs operated through unilateral extended pterional craniotomy between 2010 and 2022. The radiological characteristics, clinical features,and surgical outcomes were examined.

Results: All patients underwent surgical resection via a unilateral extended pterional approach.The mean age of patients was 62.1 years. The most common presenting symptoms were altered consciousness, seizures, headache,and anosmia. Ten (62.5%) and 6 (37.5%) patients had large (4-6 cm) and giant ( > 6 cm) OGMs, respectively. The mean tumor diameter was 6.3 cm (range:4-9). Simpson Grade2 resection was achieved in all 16 patients.

Conclusion: Unilateral extended pterional craniotomy offers a safe and effective alternative to the bilateral coronal approach for large and giant OGMs, minimizing risks of frontal lobe retraction, brain edema, and venous infarction. This approach allows for total resection with very low morbidity and mortality rates, making it a viable surgical approach for these complex tumors.

Decompressive hemicraniectomy (DHC) can improve outcome in patients with elevated intracranial pressure (ICP) refractory to medical therapy. However, this transition point for treating refractory ICPs with DHC is unclear as ICPs can often be controlled with escalating doses of medical management. A more individualized and precise way to monitor and define medically ?refractory ICP? may be achieved with the utilization of a quantitative electroencephalography (EEG) parameter called burst suppression ratio (BSR). This technical note describes a novel device to continuously gather EEG data from subgaleal electrodes. We present two cases where BSR (i.e. an EEG-derived marker) was associated with maximal cortical suppression, indicating refractory ICP and indication for decompression. Two patients [severe traumatic brain injury (sTBI) and ruptured arteriovenous malformation (AVM)] had BSRs measured through placement of novel subgaleal EEG electrodes. Although both patients had ICPs controlled by a combination of sedation, hyperosmolar therapy, and hypothermia, the BSR over a 20-24 hour period quickly reached almost-complete EEG suppression (BSR > 90%). Each case had different reasons for delaying DHC, however both reached maximal medical therapy. Given the limit of ICP control was reached, DHC was conducted in both cases. Patient 1 failed to recover and was compassionately extubated. Patient 2 clinically recovered and was discharged to acute rehabilitation. These cases illustrate that utilization of a novel subgaleal EEG system to continuously monitor BSR in patients who are being medically managed for ICP control may be used to select appropriate candidates for surgical decompression. In our two cases, a threshold BSR value > 90% (induced by medical therapy) was associated with the indication for DHC. This can be used in the future as another tool to define the limit of cortical suppression by medical therapy, thereby, indicating decompression.

Aim: To systematically evaluate the existing literature regarding adjuvant or primary treatment of chronic subdural hematoma (cSDH) with tranexamic acid (TXA).

Material and methods: This systematic review followed the parameters set by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A search in the available literature was conducted up to February 2024 in five databases using the keywords ?chronic subdural hematoma? and ?tranexamic acid.? Randomized clinical trials, prospective or retrospective cohorts, systematic reviews, and case series ( > five patients) relevant to the analysis were included.

Results: In total, 10 studies were included, encompassing a total of 912 patients diagnosed with cSDH who underwent treatment with TXA. Seven studies evaluated the use of TXA as an adjunctive to surgical treatment, and three articles investigated the effect of TXA as primary therapy.

Conclusion: TXA can be considered a safe and effective option in adjunct to surgical management. Further studies are needed to establish its role as primary treatment.

Aim: To evaluate the outcomes in low-pressure hydrocephalus (LPH) following an endoscopic third ventriculostomy, and placement of a valveless ventriculoperitoneal or ventriculoatrial shunt catheter.

Material and methods: This novel surgical technique was assessed in a prospective case series at a single center between December 2020 and December 2022. Patients were selected for the hybrid procedure based on the Pang?Altschuler diagnostic criteria for LPH. Those with normal or high-pressure hydrocephalus or less than six months of follow-up were excluded. All patients were evaluated clinically (Karnofsky performance status [KPS]) and radiologically (standardized set of images) in the preoperative and postoperative period, and their outcome was categorized as excellent, temporary improvement, or poor.

Results: This case series comprised 16 patients. The mean postoperative improvement in KPS was 56 points. All patients showed improved KPS. All follow-up scans showed radiological improvement. System dysfunction and the need for a shunt with a valve were detected in 18.75% of cases (n=3). The outcome was excellent in 81.25% of cases (n=13), and temporary improvement in 18.75% (n=3).

Conclusion: The presented series demonstrated that the hybrid procedure effectively treats LPH and has minimal number of complications.