Turkish neurosurgery最新文献

Aim: To evaluate the outcomes of decompression surgery in patients who developed malignant cerebral infarction after pharmacologic and endovascular thromboembolectomy treatment.

Material and methods: The study included 57 patients who underwent decompressive surgery for acute ischemic stroke between 2018 and 2023, having received either pharmacological treatment (intravenous tissue plasminogen activator; group A) or endovascular thromboembolectomy (group B). Age, sex, comorbid chronic diseases, location of thromboembolism at admission, side of ischemia, preoperative Glasgow Coma Scale scores, timing of surgery, and mortality rates were analyzed. The degree of recovery was measured using the modified Rankin Scale (mRS) score at 3 months.

Results: The mortality rate after decompression surgery was 48% in group A and 50% in group B. Younger patients had lower mortality rates, with 38% in group A and 50% in group B. When considering all age groups, there was no significant between-group difference in mortality. The mean mRS score was 3.92 in group A and 3.93 in group B, with no significant between-group difference.

Conclusion: Endovascular thromboembolectomy does not appear to impact mortality and recovery rate in patients undergoing decompression surgery for malignant cerebral edema.

Aim: To evaluate the long-term outcomes of nine patients who underwent myelomeningocele repair via fetoscopic surgery, open fetal surgery, and postnatal surgery.

Material and methods: The presence of inclusion cysts and the thickness of granulation tissues at the surgical site were analyzed using spinal magnetic resonance imaging (MRI) at a 7-year follow-up to determine their impact on clinical outcomes.

Results: The spinal defect levels ranged from L2 to S2. Granulation tissue at the surgical site was thicker in the prenatal open and postnatal repair groups when compared to the fetoscopic repair group. Follow-up spinal magnetic resonance imagings (MRIs) detected an inclusion cyst in one patient from the fetoscopic repair group, whereas all patients who underwent prenatal open repair and the two who underwent postnatal myelomeningocele repair developed inclusion cysts. Clinical outcomes were more favorable in the fetoscopic repair group compared to those who underwent open repair. Patients who underwent prenatal repair exhibited varying degrees of neurogenic bladder dysfunction. Although none required urological intervention, their bladder function necessitated close monitoring, and their neurological outcomes were noticeably better than their urological outcomes.

Conclusion: We believe that inclusion cysts and granulation tissue affect the clinical outcome of patients after myelomeningocele repair and should be monitored during spinal follow-up.

Aim: To identify the factors that could prevent the formation of spina bifida, and to determine the causes of hydrocephalus.

Material and methods: We retrospectively evaluated the data of 51 patients with neural tube defects (NTDs) who were surgically treated at Sanliurfa Training and Research Hospital between December 2021 and October 2022.

Results: The mean maternal folate level was 7.02 ± 3.66 ?g/L. Of the 51 mothers, 14 (27.5%) had low folate levels and 37 (72.5%) had normal folate levels. The mean maternal vitamin B12 level was 287.29 ± 91.64 ng/L. Of the 51 mothers, 9 (17.6%) had low vitamin B12 levels and 42 (82.4%) had normal vitamin B12 levels. Ventriculoperitoneal shunt (VPS) surgery was performed in 19 (37.3%) of 51 patients. The area of NTD was significantly higher in infants who underwent VPS surgery due to hydrocephalus than in infants without hydrocephalus. The risk of developing hydrocephalus increased as the severity of NTD type increased. Furthermore, the risk of developing hydrocephalus increased in patients with NTDs at higher anatomical levels.

Conclusion: Although the optimum blood folate level for preventing MMC remains uncertain, the upper limit of the normal reference should be targeted. Hydrocephalus is an important cause of morbidity and mortality in patients with SB and its incidence is higher in patients with an anatomical higher NTD, a more severe type of NTD, and a large defect diameter. Furthermore, hydrocephalus is more common in patients with SM and female patients.

Aim: To present a systematic review and to report a case of xanthomatous meningioma, aiming to contribute valuable insights into this uncommon neoplasm.

Material and methods: The guiding question focused on the epidemiological characteristics of xanthomatous meningiomas. Inclusion criteria encompassed case reports or series detailing patient sex, age, and tumor location. A literature search identified 56 articles on Pubmed and Mendeley. Study selection involved independent screening by two researchers, adhering to predefined criteria. Data collection from eligible studies included patient demographics, symptoms, MRI characteristics, and immunohistochemical markers. Statistical analysis employed SPSS software for nominal qualitative and quantitative variables.

Results: The case report involved a 44-year-old female presenting with disorientation and chronic headache, diagnosed with xanthomatous meningioma. The systematic review incorporated 21 studies and 27 patients, with a female predominance (55.2%) and an average age of 48.2 years. Most tumors were located in the frontal region (57.2%). Common symptoms included headache (21.4%) and seizures (14.2%). Recurrence occurred in only 7.6% of cases, emphasizing the favorable prognosis post-surgery.

Conclusion: Xanthomatous meningiomas, characterized by meningothelial and lipid-filled cells, remain a subject of limited research. Debates persist regarding the origin of the lipid-filled cells, whether it is from migrating macrophages or from degenerated meningothelial cells. The study highlights the epidemiology and differential diagnoses, emphasizing the importance of accurate histopathological and immunohistochemical examinations.

Silent corticotroph pituitary neuroendocrine tumours (PitNETs) are rare, aggressive tumours that exhibit clinical and biochemical silence, despite their expression of adrenocorticotrophic hormone (ACTH) and the transcription factor Tpit. They exist on a spectrum of functionality between true silent adenomas and ACTH-secreting adenomas and rarely transform into functioning corticotroph adenomas. In this report, we describe an aggressive silent corticotroph PitNET, which recurred twice following complete excision and displayed functional transformation 128 months after primary excision, with clinical and biochemical profiles suggestive of Cushing?s disease. The patient underwent re-operation followed by hypofractionated stereotactic radiotherapy. This case report demonstrates the importance of long-term clinical and biochemical follow-up in patients with silent corticotroph PitNETs, and highlights the aggressive nature of these tumours that warrants early adjuvant radiation.

Aim: To investigate the incidence of distal junctional failure (DJF) in patients undergoing posterior lumbar fusion with either semirigid polyether ether ketone (PEEK) or rigid titanium alloy rods, focusing on the impact of preoperative and postoperative spinopelvic parameters on DJF development.

Material and methods: A retrospective analysis was conducted on patients who underwent short-segment posterior transpedicular stabilization with semirigid PEEK or rigid titanium ally rods between 2015 and 2021. Preoperative and postoperative pelvic parameters, including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), PI-LL mismatch, and lower instrumented vertebra (LIV) were evaluated.

Results: The total cohort consisted of 61 patients with a mean age of 55.85 ± 11.97 years. DJF occurred in 18.03% of patients in the PEEK group (6.67%) compared to the rigid rod group (29.03%) (p < 0.05). Postoperative PI-LL mismatch was a critical factor in DJF development (p < 0.05). Among patients with a preoperative PI-LL mismatch greater than 10°, non-DJF patients achieved a correction of -55.50°. Postoperative reductions in LL were also associated with an increased risk of DJF (p < 0.05). In the PEEK group, DJF patients experienced -19.35° reduction in LL, whereas -11.02° in the rigid rod group.

Conclusion: PEEK rods were associated with a lower incidence of DJF compared to rigid titanium rods. Postoperative PI-LL mismatch and changes in lumbar lordosis and PI-LL mismatch are key predictors to prevent DJF.

Aim: To compare the outcomes and complications of stent-assisted coil (SAC) embolization for the treatment of cerebral aneurysms according to stent type.

Material and methods: Since January 2006, a total of 1293 patients have been added to our institutional aneurysm database. We excluded cases with subarachnoid hemorrhage, those not classified as Raymond Roy Class 1, and those in which flow diverters were used. Cases involving the use of overlapping stents, Y-stenting, or multiple stents were also excluded. We recorded demographic information, aneurysm characteristics, and procedural details for all patients. Patients who did not undergo diffusionweighted magnetic resonance imaging (MRI) within 1 day postoperatively or follow-up angiography within 6 months postoperatively were excluded.

Results: In total, 188 patients were included in the analysis (129 females; mean age, 58 years) who were treated for aneurysms of different sizes. Regrowth occurred in 21 patients, with the rate varying according to the stent type. In particular, the lower profile stent group had a lower regrowth rate compared to the nitinol laser stent group. The rate of postoperative infarction on diffusionweighted MRI within 1 day postoperatively varied among stent types.

Conclusion: None of the stent types demonstrated clear superiority for SAC embolization, indicating that stent selection should be based on surgeon preference. Despite the low regrowth rate, careful stent selection is essential, particularly for patients at high risk of ischemic stroke or regrowth. These findings provide valuable insights for optimizing the treatment of cerebral aneurysms using SAC embolization.

Aim: To evaluate clinical and radiological outcome in surgically treated Koos 4 vestibular schwannomas.

Material and methods: Volumetric analysis of the tumour volumes before surgery, after surgery (before radiation), and at follow-up time-points after radiation was performed. Clinical data on facial nerve function and complications were collected. Approximately 6 months after surgery, all patients were treated with a single fraction of stereotactic radiosurgery using the gamma knife radiosurgery with a mean marginal dose of 12.9 Gy to the residual tumour volume.

Results: Mean tumour volume was 11.64 cm3 which was reduced to a mean volume of 4.17 cm3 after partial resection. After a mean follow-up of 100 months, residual tumour showed a decrease in volume in 20 patients, stable disease in one patient and two patients showed progressive tumour volume requiring a second operation in one patient. Facial nerve function was preserved in all patients. One patient suffered from a trigeminal neuralgia after radiation.

Conclusion: Planned partial resection followed by radiation for patients with Koos 4 vestibular schwannoma is an effective strategy to preserve facial nerve function and achieve tumour control. Residual tumours after planned partial resection showed a mean decrease in volume of 50% at the last follow-up time point.

Aim: To evaluate the in vitro effects of hydroxychloroquine (HCQ) on histone deacetylase (HDAC) enzyme activity and interleukin (IL)-6, IL-10, and tumor necrosis factor-alpha (TNF-α) expressions.

Material and methods: Primary cell cultures were prepared. Samples that did not receive any medication constituted the control group, while culture samples treated with HCQ served as the study group. The surface morphology of cells and the extracellular matrix (ECM) were evaluated by Giemsa staining and inverted light microscopy. Cell viability, proliferation, and cytotoxicity were determined by 3-(4,5-dimethylthiazol2-yl)-2,5-diphenyltetrazolium-bromide (MTT) analysis. The cultures were simultaneously stained with acridine orange (AO)/propidium iodide (PI) and viewed under fluorescence microscopy. HDAC enzyme activity and IL-6, IL-10, and TNF-α expression were evaluated using commercial enzyme-linked immunosorbent assay kits. The obtained data were analyzed using statistical methods. The alpha significance level was accepted as p < 0.05.

Results: HCQ applied to cell cultures at the tested doses and durations showed cytotoxic effects on cell viability, proliferation, and cell or ECM morphology. It increased HDAC activity in chondrocytes and caused a proinflammatory response, indicated by an increase in TNF-α in the cells (p < 0.05).

Conclusion: The results of this study emphasized that the cytotoxic effect of HCQ increased HDAC activity; therefore, this proinflammatory response should be taken into consideration in the clinical use of HCQ.

Aim: To investigate the morphology of sella turcica (ST) in Chiari malformation type I (CM-I) using computed tomography.

Material and methods: The size and shape of ST were examined using the radiological images of 32 CM-I patients (21 female/11 male, mean age: 26.09 ± 15.39 years), and 32 normal participants (19 female/13 male, mean age: 28.56 ± 19.37 years).

Results: The height, diameter, width, and length of ST were similar in CM-I and control groups (p > 0.05). According to the Axelsson classification, the ST shape in CM-I was identified as normal in 16 patients (50%), oblique anterior wall in 2 patients (6.25%), irregularity in 6 patients (18.75%), and pyramidal shape of the dorsum sellae in 8 patients (25%). In controls, the ST shape was identified as normal in 18 patients (56.25%), oblique anterior wall in 4 patients (12.50%), irregularity in 2 patients (6.25%), and pyramidal shape of the dorsum sellae in 8 patients (25%). According to the Camp classification, the ST shape in CM-I was identified as oval in 6 patients (18.80%), round in 21 patients (65.60%), and flattened in 5 patients (15.60%). In controls, the ST shape was identified as oval in 19 subjects (59.40%), round in 10 patients (31.30%), and flattened in 3 patients (9.40%).

Conclusion: The size of ST in patients with CM-I was similar to that in healthy partcipants. The only difference in ST morphology was that patients with CM-I had more round-shaped sella, whereas normal subjects had more oval-shaped sella.