Effectiveness and success rates of endoscopic third ventriculostomy in patients under 2 years old

Objective: Endoscopic third ventriculostomy (ETV) stands out as an important option in the treatment of hydrocephalus without shunts. Endoscopic third ventriculostomy (ETV) has become more popular due to recent technical developments in endoscopic systems. But the urge of the physician, to provide a shuntfree survival for his patients, leads to performing the procedure in a unsuitable group of patients. Compared with shunt surgery, ETV presents a more physiological solution for the treatment of hydrocephalus. ETV is accepted as the first-line treatment method in many centers in appropriate cases in the treatment of obstructive hydrocephalus. The aim of this study is to examine the results of patients under the age of two underwent endoscopic third ventriculostomy. Methods: 79 patients who underwent ETV between 2011 and 2020 in our clinic and who were under 2 years of age at the time of operation were retrospectively analyzed. Results: 45 of 79 patients were male babies and 34 were female babies. The average age of the patients is 7 months (1 day - 22 months). In 39 (49.3%) patients, there was no need for repeat surgery in their follow-up after ETV. ETV procedure was repeated in 5 (6.3%) patients, and ventriluloperitoneal shunt (VPS) surgery was performed in 2 (2.5%) patients. In 13 patients, ventriculoperitoneal shunt was applied from the anterior and presented with shunt dysfunction. VPS surgery was not performed again after ETV in 3 (23%) of 13 patients after ETV. Conclusions: ETV can also be applied to patients younger than two years of age, and this treatment can give patients the chance to live a life independent of shunt.

Parkinson hastalığının hayvan modelleri ve kök hücre temelli deneysel çalışmalar

Parkinson hastalığı (PH) ikinci en yaygın ilerleyici nörodejeneratif olup, genetik vakalar azınlıkta olup, altta yatan etyopatofizyoloji hala bilinmemektedir. Halen, kanıtlanmış ve kesin bir tedavi mevcut değildir. Yeni terapötik stratejilerin taranması ve test edilmesi için kullanılabilecek güvenilir hayvan modelleri geliştirmek çok önemlidir, mesela, sadece semptomatik tedaviler geliştirmek yerine gerçek patojenik süreci hedefleyen kök hücre tedavileri gibi. Burada, PH’nin güncellenmiş in vivo ve in vitro modellerini özetledik ve bu modelleri kullanarak kök hücre temelli deneysel çalışmaları gözden geçirdik.

Cushing hastalığının etyopatogenezinde genomik değişiklikler ve moleküler mekanizmalar

Hipofiz bezinin ön bölümü (adenohipofiz) vücudumuzdaki diğer iç salgı bezlerinin çalışmasını kontrol eden, 5-7 mm büyüklüğünde bir salgı bezidir. Adenohipofiz, çeşitli trofik hormonları salgılamak üzere farklılaşmış hücreler içerir. Bu hücrelerin çeşitli genetik, epigenetik ve çevresel faktörlerle etkileşimi sonucunda çoğunluğu iyi huylu olan hipofiz tümörleri (hipofiz adenomları) ortaya çıkabilir. Hipofiz adenomları arasında tanı ve tedavisi en zor olarak bilinen ACTH-salgılayan adenomlar böbreküstü bezini aşırı uyararak kontrolsüz miktarda kortizol salgılanmasına neden olur. Vücutta yol açtığı değişikliklere Cushing hastalığı adı verilir. Cushing hastalığının USP8, USP48, EGFR, p16, p21 gibi birçok farklı genin işlevinin kaybolmasına bağlı olarak ortaya çıktığı bilinmektedir. Bunun dışında ilgili genlerin metillenmesi ve asetillenmesi gibi çeşitli epigenetik modifikasyonlar ve miRNA’lar gibi çeşitli düzenleyicilere maruz kalması sonucunda da Cushing hastalığı görülmektedir. Bu genlerin ve proteinlerin işlevlerinin belirlenmesi sayesinde yeni tedavi stratejilerinin geliştirilmesi mümkün olacaktır.

Perkütan vertebroplasti uygulanan postmenopozal hastalarda osteoporoza eşlik eden sistemik hastalıklar

Amaç: Vertebroplasti ilk kez 1984 yılında vertebra hemanjiomu olan bir hastada uygulanmıştır. Ortalama yaşam süresinin artması osteoporoz olgu sayısındaki artışa paralel olarak vertebral çökme kırıklarının görülme sıklığını da artmıştır. Pediküllerden vertebra gövdesine polimetilmetakrilat (PMMA) enjeksiyonunu içeren minimal invaziv bir tekniktir. Bu çalışmada perkütan vertebroplasti (PVP) uygulanan vertebra kompresyon kırığı (VKK) olan postmenopozal osteoporozlu (PMO) hastalarda eşlik eden hastalıklar ve bu hastalıkların sıklıkları değerlendirildi. Gereç ve Yöntem: Nöroşirürji kliniğimizde Mayıs 2015-Mayıs 2019 tarihleri arasında PVP uygulanan VKK olan PMO’lu 69 kadın hasta retrospektif olarak gözden geçirildi. Hastaların demografik verileri ile birlikte eşlik eden sistemik hastalıkları hasta dosyalarından kaydedildi. Bulgular: Çalışmamıza dahil edilen hastaların yaş ortalamaları 73,30 ± 9.09 (49-92 yıl) yıldı. Hipertansiyon, eşlik eden sistemik hastalıklar arasında %39,1’lik oranıyla ilk sırada yer aldı. Sonra azalan sırayla osteoartrit (OA), tip II diyabetes mellitus (DM), gastrointesitinal sistem hastalıkları, kardiyak hastalıklar, serebrovasküler hastalıklar, Alzheimer hastalığı, kronik obstruktif akciğer hastalığı (KOAH), geçirilmiş spinal cerrahi, tiroid hastalıkları, anemi, kronik böbrek yetmezliği (KBY), epilepsi, sigara, glokom, malignite ve depresyon saptandı. Özgeçmişinde özellik olmayan hasta sayısı ise %13’tü. Sonuç: Ülkemizde ve tüm dünyada özellikle yaşlı popülasyonda sık görülen PMO’un sistemik hastalıklar ve bazı cerrahi müdahalelerle şiddeti artabilir veya tedavisi bozulabilir. Osteoporozdan ve eşlik eden sistemik hastalıklardan korunmak cerrahi girişim uygulamaktan daha önemlidir.

Spinal intradural endodermal cyst

Purpose: Epithelial cysts of the central nervous system, according to the type of cell origin; neuroepithelial or endodermal type. Endodermal cysts are rare forms of benign tumors. In this presentation, we present a 35-year-old male patient with typical histopathologic features and due to the presence of this rare lesion. We aimed to present this rare case and emphasize the importance of cystic epithelial cell differences. Methods: Neurenteric cysts, cyst lining epithelium of cell types were analyzed using immunohistochemical diagnostic methods. Results: The importance of the cell type in the endodermal cyst is also emphasized and the frequency of recurrence in cysts that have goblet-columnar epithelial component. This epithelium is increasing the risk of recurrences. However, the other cause of recurrence is also incomplete excision. Therefore, the complete excision of ECs is important, not only for avoiding recurrence but also for differentiating cell types for ECs and predicting recurrence risk. Conclusions: The precise pathologic diagnosis of cell type determines the risk of recurrence. Neurosurgeons should exert their best efforts to achieve complete excision of the cysts.

Multimodal Treatment in Glioblastomas

Glioblastomas are the most common primary brain tumors. Despite aggressive resection, radiotherapy and concomitant chemotheraphy overall survival is 14-16 months, and 5 year survivial rate is only 2%. The poor prognosis required development of new treatment modalities. Tumor Treating Fields, molecularly targetted drugs, antiangiogenic molecules, immune checkpoint inhibitors, tumor vaccines, Chimeric Antigen Receptor-T cell, viral theraphy and oncolytic viruse and mesenchymal stem cell vectors are some of the modalities that are currently being developed.

Medical Treatment in Spinal Cord Injury

Spinal cord injuries cause psychological in humans and require expensive care and treatments. In recent years, various pharmacological agents have been tested in acute spinal cord injuries. Prospective randomized controlled clinical trials on a large scale have failed to demonstrate significant neurological progression, in contrast to their success in the laboratory. The search for an effective neuroprotective pharmacological agent to prevent secondary damage in acute spinal cord injuries remains primary goals for basic sciences and clinicians.

Results of using Thoracolumbar Injury Classification and Severity Score (TLICS) in Treatment of Thoracolumbar Fractures

Aim: To compare short and long term pain intensity changes and long term loss of correction rates in patients who were treated either by kyphoplasty or posterior segmentation due to their TLICS and LSC scores, therefore evaluate the specificity of these classifications. Material and Methods: Medical records of 106 patients operated due to thoracolumbar compression or burst fracture in our clinics between years 2012 to 2015 have been evaluated retrospectively. The patients were evaluated with postoperative radiography (loss of reduction) and visual analogue scale (VAS) in their follow-ups. Results: The average stay on hospital was 6.53 ± 4.51 days in kyphoplasty group. The mean preoperative cobb angle was 10.76±11.67 degrees, which improved to 10.19±10.66 degrees at postoperative 1th month. Beside this, the mean preoperative VAS score was 7.93±0.68 then improved to 4.25±0.77 and 2.75 ± 1.43 at postoperative 6th, 12th month follow-ups respectively. There were 42 patients in instrumentation group. The mean hospitalization was 13.47±10.43 days. The mean preoperative cobb angle was 15.84±10.52 and it improved to 11.86±8.15 degrees at the postoperative 1th-month follow-up. The preoperative VAS scores of the patients improved from 7.71±0.71 to 4.09±0.79 and 4.26±1.23 at 6th and 12th month follow-ups. Conclusion: In long term follow up the kyphoplasty group showed more loss of correction however lesser VAS scores comparing to the instrumentation group. Although evaluating TLICS scores to kyphoplasty patients is still based on case reports in our series it was performed to 64 patients.

Classifications Used in Spinal Cord Injuries

Creating a common language allows information to be shared well/wholesome/healthily. Classifications have a important role in the formation of this language, which provides many benefits such as follow-up of the clinical course. Classifications in spinal cord injuries are based on examination, so the results of different treatments can be revealed more clearly with a standardized examination and registration. The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) which is the most sensitive and common classification was developed by the American Spinal Injury Association (ASIA) and the International Spinal Cord Society (ISCoS), although its foundations were laid in 1969 by Frankel. Apart from neurological evaluation, there are scales such as Functional Independence Scale, Modified Barthel Index, Spinal Cord Independence Scale, Quadriplegia Functional Index, Walking Index for Spinal Cord Injury, Spinal Cord Injury Functional Ambulation Inventory to determine the functional status in spinal cord injuries. Additionally scales such as Assessment of Spinal Cord Injury Basic Pain Data Set, Multidimensional Pain Inventory, DN4 (DouleurNeuropathique DN4) can be used for pain assessment in a patient with spinal cord injury.

History of Neuroendoscopy

two hundred years of design, endoscopy is widely used today in neurosurgical interventions for intraventricular surgery, skull base surgery, spinal surgery and various other applications. Neuroendoscope, which had fallen off the agenda in the early 1900s due to unsuccessful surgical interventions, was re-used to assist microsurgery in the future. It has become an indispensable equipment of the neurosurgery operating room itself, rather than the complementary feature of the neuroendoscopy, which has increased effectiveness in the development of technology. In this article, our aim is to tell the history of neuroendoscopy used in current neurosurgical field to physicians.