Zafer Yüksel

Background and Objectives: We aimed to determine whether preoperative systemic inflammatory markers derived from complete blood count differ between patients with intradural spinal tumors and healthy controls, and whether any such difference varies by pathological subtype or motor deficit status. Materials and Methods: Sixty-four patients who underwent surgery for histopathologically confirmed intradural spinal tumors between 2015 and 2023 were enrolled alongside 64 age- and sex-matched healthy controls. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), pan-immune-inflammation value (PIV), and red cell distribution width (RDW) were calculated from preoperative complete blood count results. Comparisons were performed at the patient–control level and stratified by pathological diagnosis (meningioma, schwannoma, ependymoma, other) and motor deficit status. Results: NLR (median 2.47 vs. 2.06; p < 0.001), PLR (157.1 vs. 121.0; p < 0.001), SII (706.1 vs. 595.0; p = 0.003), and PIV (404.2 vs. 287.0; p < 0.001) were all significantly elevated in the tumor group, while LMR was significantly lower (3.66 vs. 4.34; p < 0.001). RDW did not differ between groups (p = 0.420). Stratification by pathological subgroup and motor deficit status revealed no significant differences in any marker. Conclusion: Intradural spinal tumors—including the predominantly benign cases that made up most of this cohort—are accompanied by a detectable preoperative shift in systemic inflammatory markers, one that appears independent of tumor histology and neurological presentation. These findings demonstrate a measurable systemic inflammatory response in patients with intradural spinal tumors. However, the absence of differences across pathological subtypes and motor deficit status suggests that these markers reflect a generalized host response rather than tumor-specific characteristics, and their role in clinical decision-making remains to be clarified.

Objective: This study aimed to compare the clinical outcomes of navigation-assisted and conventional (freehand) ventriculoperitoneal (VP) shunt placement in pediatric hydrocephalus patients. Methods: A retrospective review was conducted of 164 patients under the age of 18 who underwent VP shunt placement for hydrocephalus between 2015 and 2023 and had a minimum postoperative follow-up of 12 months. The conventional technique was used in 116 patients. The navigation-assisted technique (intraoperative ultrasonography or frameless neuronavigation) was used in 48 patients. Demographic data, hydrocephalus etiology, catheter tip position (Yim classification), revision rates, infection, complications, and length of hospital stay were recorded. Catheter tip position was assessed on postoperative imaging by two independent investigators. Results: No significant differences were found between the groups in terms of age, sex, and hydrocephalus etiology. The optimal catheter placement rate was significantly higher in the navigation-assisted group compared to the conventional technique (81.25% vs. 60.34%, p = 0.017). The revision rate was significantly lower in the navigation-assisted group (16.67% vs. 38.79%, p = 0.010). The mean hospital stay was shorter in the navigation-assisted group (7.85 ± 3.97 days vs. 10.20 ± 3.70 days, p < 0.001). The groups were similar in terms of infection (2.08% vs. 9.48%, p = 0.183) and overall complication rates (14.58% vs. 16.38%, p = 0.959). Conclusions: Navigation-assisted VP shunt placement in pediatric hydrocephalus patients is associated with a high rate of optimal catheter position, a low revision rate, and a short hospital stay. These findings support the use of navigation technology in pediatric hydrocephalus surgery, but also reveal that infection and complications are unassociated with the surgical technique.

Aim: This study aimed to evaluate the diagnostic performance of the Delta Neutrophil Index (DNI) and Neutrophil-to-Lymphocyte Ratio (NLR) in distinguishing malignant from benign primary brain tumors during the preoperative period. Methods: This retrospective cohort study was conducted at a tertiary university hospital. A total of 140 participants were included 60 patients with malignant glial tumors, 50 patients with benign brain tumors, and 30 healthy controls without inflammatory, infectious, or hematologic disease. Preoperative complete blood count results obtained within seven days before surgery were analyzed. Results: Patients with malignant tumors were significantly older than those in the benign and control groups (p < 0.001). DNI, NLR, PLR, MLR, and SII values were all significantly elevated in the malignant group (p < 0.001, for all comparisons). ROC analysis revealed high diagnostic accuracy for DNI (AUC = 0.847) and NLR (AUC = 0.850), with optimal cut-off values of 3.50 and 3.95, respectively. In multivariable logistic regression adjusted for age, DNI > 3.5 (OR = 20.67; 95% CI: 3.35–127.64; p = 0.001), NLR > 3.95 (OR = 21.17; 95% CI: 3.28–136.50; p = 0.001), and CRP (OR = 1.52; 95% CI: 1.20–1.93; p = 0.001) remained independent predictors of malignancy. The combined model including DNI and NLR achieved the highest diagnostic accuracy (AUC = 0.937; age-adjusted AUC = 0.943), with a sensitivity of 88.3% and a specificity of 86.0% after age adjustment. Conclusions: Both DNI and NLR demonstrated significant value in differentiating malignant from benign primary brain tumors prior to surgery, with DNI emerging as the most powerful independent predictor. The combined use of DNI and NLR substantially improved diagnostic accuracy, suggesting that simple hematologic indices may serve as practical, noninvasive adjunctive tools in the preoperative assessment of brain tumor malignancy. These markers may assist in surgical prioritization, patient counseling, and clinical decision-making, particularly in resource-limited settings.

Objective: Arachnoid cysts are benign lesions frequently encountered owing to the widespread use of neuroimaging. Although they are usually asymptomatic, they can cause various symptoms depending on the location of the cyst, its size, and its effect on the flow of the CSF. If they are symptomatic, surgical intervention may be required. Herein, we aimed to investigate the incidence, clinical findings, follow-up, and management of arachnoid cysts in patients in the context of the literature. Material and Methods: Between January 2017 and December 2022, the brain magnetic resonance images (MRI) of 30073 patients were examined in our hospital; 751 patients with arachnoid cysts were identified. The demographic characteristics, cyst location and size, clinical symptoms, follow-up, and treatment processes of these patients were examined. Results: Overall, 218 patients (29%) were aged ≤18 years, and 533 (71%) were aged >18 years. The incidence of arachnoid cysts was 5.3% in the ≤18 years age group and 2% in the >18 years age group. The incidence of arachnoid cysts in the general population was 2.5%. In terms of sex distribution, 351 patients (47%) were women and 400 patients (53%) were men, with the incidence of arachnoid cysts being two times more common in men than in women. The distribution of the cases according to localization revealed that arachnoid cysts were detected most commonly in the posterior fossa (n=330; 44%), Sylvian fissure (n=226; 30%), cerebral convexity (n=100: 13%), and more than one location (n=74; 9.9%). Data regarding follow-up imaging were available for 298 patients. No significant increase in the size of the cyst was observed during follow-up. Conclusion: Arachnoid cysts are commonly observed during neuroimaging. Although there is a consensus regarding the diagnosis of arachnoid cysts and follow-up of asymptomatic patients, larger case series are warranted to standardize the use of advanced examinations for treating symptomatic patients and selecting appropriate surgical techniques.

Carpal tunnel syndrome (CTS) is a condition in which the median nerve is compressed between the transverse ligament and the carpal bones. There are various techniques used in the surgical treatment of CTS. The present study aimed to investigate the reasons for reoperation by examining the reoperated cases diagnosed with CTS. Patients who underwent surgery for CTS at Kahramanmaraş Sütçü İmam University Department of Neurosurgery between January 1, 2015 and September 1, 2022 were evaluated retrospectively. All patients were operated by the same surgical team. Patients who underwent two or more operations with the same diagnosis were included in the study, while those operated for the first time due to CTS and with missing data were excluded. The included patients were analyzed in terms of gender, age, occupation, side of the surgery, presence of systemic diseases causing CTS such as diabetes mellitus (DM), number of the operations they underwent, time until the next operation, surgical technique, and medical branch that performed the surgery (orthopedics, neurosurgery, or plastic surgery). Forty-eight patients who met the study criteria were evaluated. Out of the 48 reoperated patients, 14 were male and 34 were female. Eighteen patients had been operated using the mini-incision open method, while 22 had undergone laparoscopic surgery, including 14 patients with biportal endoscopic surgery, and eight with uniportal endoscopic surgery. Out of the 48 patients, 31 (64.6%), 11 (22.9%), and six patients were first operated by orthopedic and traumatology physicians, plastic and reconstructive surgeons, and neurosurgeons, respectively. The use of open surgical technique is the gold standard in CTS and complete incision of the transverse ligament provides complete decompression of the median nerve. We believe that decompression with closed or small incisions due to aesthetic concerns may not be sufficient and may increase the risk of complications.

Purpose Oxidative stress in the vertebral endplates of patients with low back pain and Modic changes (MCs) (types I, II, and III) endplate changes on magnetic resonance imaging. 8-iso-prostaglandin F_2α (8-iso-PGF_2α) has been proposed as new indicator of oxidative stress. Raftlin, as an inflammatory biomarker, has been previously reported in inflammatory diseases. Oxidative stress plays an important role in various human diseases. This study was aimed to assess Raftlin and 8-iso-PGF_2α levels in patients with MCs. Methods Patients with MCI, II, and III (n = 45) and age- and sex matched controls subjects (n = 45) were enrolled in this study. 8-iso-PGF_2α and Raftlin levels in the serum samples of both groups were measured with enzyme-linked immunosorbent assay. Results In our study results, raftlin levels changed in parallel with prostaglandin levels (p < 0.05). Raftlin levels changed in parallel with prostaglandin levels (p < 0.05). The levels of 8-iso-PGF_2α and Raftlin levels showed increase in patients with MCs and the control group (p < 0.05). In addition, a significant positive correlation was found between MC-I, MC-II, MC-III and Raftlin (r = 0.756, 0.733, 0.701 p < 0.001, respectively). A significant positive correlation was found between ISO (Respectively; r = 0.782, 0.712, 0.716 p < 0.001). In our evaluation between Raftlin and Iso, a significant positive relationship was determined. (r = 0.731, p < 0.001). Conclusion Our findings indicated that oxidative stress in patients with MC-I may be aggravated and it may cause an inflammation formation of the lesion areas in these patients. Also, the increased 8-iso-PGF_2α and Raftlin levels in patients with MC-II and MC-III may be an adaptive response to against oxidative stress.

Background/aim: Caudal epidural steroid injection (CESI) has been increasingly used for treating lower back pain. However, there is still significant controversy about the efficacy and safety of different imaging techniques used to guide CESI. In this context, the objective of this study is to compare the efficacies of fluoroscopy- and ultrasonography-guided CESI in patients with chronic lower back pain. Materials and methods: The population of this retrospective, observational study consisted of all consecutive patients who underwent CESI for lower back pain between 2018 and 2020. Of the 371 patients included in the study sample, 192 had undergone fluoroscopy- guided CESI (Group F) and 179 ultrasonography-guided CESI (Group U). Patients' pain and functional statuses were evaluated using the visual analog scale (VAS) and Oswestry Disability Index (ODI) immediately before (baseline) and after the procedure (postintervention day 0-D0), during the second week (D15), the first month (D30), and the third month (D90) after the procedure. Results: The mean age of Group F was significantly higher than that of Group U (p < 0.001). The number of patients with lumbar disc hernia was significantly higher in Group U, whereas the number of patients with spinal stenosis and lumbar disc hernia + spinal/lumbar stenosis was significantly higher in Group F (p = 0.001). The baseline and D0 ODI scores were significantly lower in Group U than in Group F (p = 0.006 and p = 0.017, respectively). There was no significant difference between the groups in other VAS and ODI scores (p > 0.05). Intragroup analyses revealed significant reductions in VAS and ODI scores over the follow-up period till D30 compared to the baseline scores in each group (p < 0.001). The decrease recorded in the ODI score between the D15 and baseline measurements was significantly higher in Group F than in Group U (p = 0.006). Conclusion: The CESI was as effective as fluoroscopy-guided CESI in treating chronic lower back pain.

Objective: Geriatric patients are more prone to traumatic injuries, particularly cranial traumas and spinal fractures resulting from falls, due to osteoporosis and sedentary lifestyles. As a primary measure against the Covid-19 pandemic, Turkey put into effect a lockdown for people aged 65 and above. This study aimed to compare the change in the number of cranial and spinal trauma cases in the age group of 65 and above who were placed under lockdown between 21st March and 3rd June 2020 with the number in the previous year. Materials and Methods: The study included patients aged 65 and above who presented to the emergency departments and neurosurgery clinics of two trauma centres in our city with cranial and spinal traumas between 21st March and 3rd June in 2019 and 2020. The patients were retrospectively categorised in terms of age, gender, type of trauma and treatment. Results: In total, 83 patients presented to the hospital between 21st March and 3rd June 2019 while only 12 patients presented between 21st March and 3rd June 2020 (p

Amaç: Bu çalışmada Kahramanmaraş ili sınırları içerisinde doğan bebeklerde nöral tüp defekti (NTD) sıklığının belirlenmesi, NTD’li bebeğe sahip ailelerin sosyo-demografik özelliklerinin, annelerin gebelikleri süresince özellikle ilk trimestrda teratojen etkenlere maruz kalıp kalmadığının araştırılmasıdır. Gereç ve Yöntemler: Ocak 2000-Aralık 2013 tarihleri arasında Kahramanmaraş ili sınırları içerisindeki canlı ve ölü doğum kayıtları retrospektif olarak değerlendirilmiş ve Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi Hastanesi Nöroşirurji kliniği dahil Kahramanmaraş ilinde Nöroşirurji kliniği barındıran tüm hastanelerde NTD tanısı alan hastalar incelenmiştir. Sosyodemografik özellikler, gebeliğin ilk trimestrında karşılaşılan teratojen etkenler, anne ve babaların meslekleri, aylık maddi gelirleri ve akrabalık durumları, annelerin ateşli hastalık geçirme öyküsü, ilaç ve alkol kullanımları anket yöntemiyle değerlendirildi. Bulgular: Çalışmamızda 907 NTD’li hasta değerlendirildi. Hastaların 702’sinde (%77.4), spina bifida, 528’inde (%58.2) meningomyelosel,134’ünde (%14.8) meningosel, 40’ında (%4.4) dermal sinüs traktı, 107’sinde (%11.8) anensefali, 98’inde (%10.8) ensefalosel tanısı mevcuttu. Kahramanmaraş ilinde NTD sıklığı ‰3.83 olarak bulundu. Hastalardan 574’ü (%63.2) kadın, 333’ü (%36.8) erkek cinsiyetteydi. Olguların ebeveyn meslekleri değerlendirildiğinde işsizler veya ayda birkaç gün işçi olarak çalışanlar anlamlı oranda yüksekti. Ailenin gelir seviyesi ve annelerin eğitim seviyesi düşüktü. NTD’li bebeğe sahip annelerin gebelikleri sırasında folik asit preperatı kullanım oranının ise çok düşük olduğu görüldü (%11.4). Sonuç: Çalışmamızda Kahramanmaraş ilinde NTD görülme sıklığı ülkemizdeki benzer çalışmalar içinde göreceli olarak yüksek bulunmuştur. NDT’li bebeklerin ailelerinin düşük sosyoekonomik düzeyde olması ve annelerin yetersiz eğitim seviyeleri sonucu gebelik öncesi dönemde veya gebelik esnasında folik asit kullanımının ilimizde ciddi olarak düşük olması bu yüksek NTD sıklığının sebebi olabilir. Ayrıca NTD hastalarında doğumda veya sonradan ortaya çıkabilecek ek patolojiler olabileceği ve bu hastaların multidisipliner yaklaşımla, deneyimli kliniklerce takip ve tedavisinin yapılması gerektiği sonucuna ulaşılmıştır.