Zuhtu Ozbek

Background: Meningiomas exhibit considerable biological heterogeneity that is not fully captured by histopathological grading. Tissue-based molecular markers may provide complementary insight into tumor biology within routine diagnostic settings. Methods: Formalin-fixed paraffin-embedded tissue samples from 65 intracranial meningiomas and 13 non-neoplastic controls were analyzed. Aquaporin-4 (AQP4) expression was assessed using immunohistochemistry, while miR-216a, miR-320a, and LINC00461 levels were quantified by means of RT-qPCR. Expression patterns were compared across groups and evaluated in relation to histological grade. Results: AQP4 expression was significantly reduced in meningiomas compared with controls and showed a further decrease in higher-grade tumors. Although expression of miR-216a and miR-320a was also lower in tumor samples, these differences did not reach statistical significance. Correlation analysis revealed modest but significant associations between AQP4 and miR-216a, as well as between miR-216a and miR-320a. Individual markers demonstrated limited discriminatory performance; however, combined expression patterns suggested underlying molecular variability across tumor grades. Conclusions: Our findings indicate that AQP4 downregulation represents a consistent feature in meningiomas, while associated microRNA alterations may reflect coordinated but context-dependent expression patterns. Although these markers are not sufficient as standalone diagnostic tools, their combined tissue-level assessment may provide complementary information on tumor heterogeneity. These findings should be interpreted as exploratory and highlight the need for further validation in larger and mechanistic studies.

Primary intramuscular hydatid disease of the paraspinal muscles is exceptionally rare, particularly in the absence of hepatic or pulmonary involvement. Its nonspecific clinical and radiological features often mimic soft tissue tumors, creating diagnostic challenges for neurosurgeons practicing in endemic regions. A 22-year-old woman presented with a slowly enlarging, mildly painful right lumbar paraspinal mass without animal exposure or systemic symptoms. Magnetic resonance imaging revealed a multiloculated cystic lesion extending from L2 to L4 that lacked definitive hydatid features and could not be clearly distinguished from a synovial cyst, cystic schwannoma, abscess, or epidermoid cyst. Serology showed positive Echinococcus granulosus IgG (ELISA). The patient underwent posterior en bloc excision. Intraoperative management included meticulous containment and irrigation with 3% hypertonic saline and povidone-iodine for approximately 10 minutes, followed by copious saline washout. Gross pathology revealed multiple daughter cysts, and histopathology confirmed a hydatid cyst with laminated and germinal layers. Albendazole (400 mg twice daily) was administered for 3 months. At 8 months of follow-up, the patient remains asymptomatic with no radiological recurrence. Hydatid disease should be considered in the differential diagnosis of paraspinal cystic lesions, even in young patients without exposure history or visceral involvement. Early recognition, intact surgical excision, use of scolicidal agents, and appropriate antiparasitic therapy are critical to preventing recurrence.

Background/Objectives: Aneurysmal subarachnoid hemorrhage (aSAH) is frequently complicated by cerebral vasospasm, a major contributor to delayed cerebral ischemia and poor neurological outcomes. Early prediction remains challenging, and there is a critical need for reliable biomarkers. MicroRNAs (miRNAs) in cerebrospinal fluid (CSF) have emerged as promising indicators of acute neuropathological changes. This study aimed to evaluate CSF miRNA expression profiles in patients with aSAH to identify early predictors of vasospasm and improve clinical risk stratification. Methods: We conducted a prospective observational study involving 48 patients (40 patients with aSAH (20 who developed vasospasm, 20 who did not) and 8 healthy controls). A panel of 20 candidate miRNAs was analyzed in CSF samples collected on days 1 and 5 post−hemorrhage using quantitative real−time PCR. Expression differences between groups were assessed, and receiver operating characteristic (ROC) curves were used to evaluate diagnostic performance. Results: Several miRNAs were differentially expressed in patients who developed vasospasm. On day 1, miR−221−3p and miR−183−5p were significantly upregulated (p = 0.014, p = 0.009), while miR−126, miR−29a, and miR−27b−3p were downregulated (p = 0.006, 0.021, 0.028) compared with controls. MiR−126 remained suppressed on day 5 (p = 0.002). These early changes showed high predictive accuracy (e.g., day 1 AUC for miR−221−3p ≈ 0.98, 95% CI 0.83–1.00). Compared with non−vasospasm patients, miR−221−3p was lower (0.12−fold), while miR−9−3p and miR−183−5p were higher (13.4−fold and 2.7−fold, respectively; all p < 0.01). MiR−24 and miR−21−5p correlated with more severe grades and poorer outcomes (p < 0.05). Conclusions: Specific CSF miRNAs—particularly miR−221−3p, miR−9−3p, and miR−183−5p—may serve as early biomarkers for vasospasm, warranting further validation in larger cohorts.

Background/Objectives: Aneurysmal subarachnoid hemorrhage (aSAH) is frequently complicated by cerebral vasospasm, a major contributor to delayed cerebral ischemia and poor neurological outcomes. Early prediction remains challenging, and there is a critical need for reliable biomarkers. MicroRNAs (miRNAs) in cerebrospinal fluid (CSF) have emerged as promising indicators of acute neuropathological changes. This study aimed to evaluate CSF miRNA expression profiles in patients with aSAH to identify early predictors of vasospasm and improve clinical risk stratification. Methods: We conducted a prospective observational study involving 48 patients with aSAH (20 who developed vasospasm, 20 who did not) and eight healthy controls. A panel of 20 candidate miRNAs was analyzed in CSF samples collected on days 1 and 5 post-hemorrhage using quantitative real-time PCR. Expression differences between groups were assessed, and receiver operating characteristic (ROC) curves were used to evaluate diagnostic performance. Results: Several miRNAs were differentially expressed in patients who developed vasospasm. On day 1, miR-221-3p and miR-183-5p were significantly upregulated (p = 0.014, p = 0.009), while miR-126, miR-29a, and miR-27b-3p were downregulated (p = 0.006, 0.021, 0.028) compared to controls. MiR-126 remained suppressed on day 5 (p = 0.002). These early changes showed high predictive accuracy (e.g., day-1 AUC for miR-221-3p ≈ 0.98, 95% CI 0.83–1.00). Compared to non-vasospasm patients, miR-221-3p was lower (0.12-fold), while miR-9-3p and miR-183-5p were higher (13.4-fold and 2.7-fold; all p < 0.01). MiR-24 and miR-21-5p correlated with more severe grades and poorer outcomes (p < 0.05). Conclusions: Specific CSF miRNAs—particularly miR-221-3p, miR-9-3p, and miR-183-5p—may serve as early biomarkers for vasospasm, warranting further validation in larger cohorts.

Amaç: Spondilodiskitis, her ne kadar nadir görülen bir omurga sorunu olsa da yüksek morbiditeye sahip, uzun ve ekonomik açıdan yüksek sağlık harcamalarına neden olan özellikle cerrahi tedavide tam kabul görmüş algoritmaları olmayan ciddi bir omurga-omurilik hastalığıdır. Spondilodiskitis; diskit, osteomyelit, epidural apse, menenjit, subdural ampiyem ve spinal kord apsesini içeren bir spektruma sahiptir. Konservatif tedavi doğru alınan mikrobiyolojik örnekleme sonrası uygun antibiyoterapinin verilmesi, hastanın immobilizasyonu, klinik ve radyolojik açıdan omurganın yapısının yakın izlenmesi şeklindedir. Minimal invaziv işlemlerle örneklemenin yapılamadığı, klinik açıdan ciddi ağrı ve/veya nörolojik defisit varlığında, apse formasyonu oluştuğunda, omurgada deformatik değişiklikler varlığında cerrahi tedavi gerekli hâle gelir. Bu çalışmada, cerrahi tecrübelerimizi ve yaklaşımlarımızı bildirerek literatüre katkı sağlamanın yanında hastalığın kendi popülasyonumuzdaki sıklığı, morbiditesi, enfektif ajanın tespiti, prognozu gibi epidemiyolojik verilerin elde edilmesini sağlaması amaçlanmıştır. Gereç ve Yöntemler: 2012-2022 yılları arasında kliniğimizde spondilodiskitis tanısı alıp tedavi uygulanan 52 erişkin hastanın klinik ve radyolojik özellikleri, laboratuvar bulguları, yapılan tedaviler çalışmaya dâhil edilmiştir. Bulgular: On dört (%26) hastanın yapılan açık cerrahi ile örneklemesinde patojen bakteri tespit edilememekle beraber alınan patoloji incelemeleri iltihabi granülasyon dokusu ile uyumlu gelen hastalardı. Diğer grupta 10 Mycobacterium tuberculosis, 6 Brucella, 1 Candida glabrata üremesi oldu. Yirmi bir hasta piyojenik spondilodiskitli hastalardı. Piyojenik spondilodiskitli hastaların 8'i Staphylococcus aureus, diğer 13 hastada etkenler Staphylococcus epidermidis, Staphylococcus hominis, Escherichia coli, Pseudomonas, Acinetobacter'dir. Sonuç: Spondilodiskitis, multidisipliner yönetimi olan, hastaya göre değişen cerrahi yaklaşımları gerektiren uzun süreli ve yüksek sağlık maliyeti olan bir hastalıktır.

Extramedullary plasmacytoma and solitary plasmacytoma are localized neoplasms. Solitary plasmacytoma of bone consists about 4% of malignant plasma cell tumors. A plasmacytoma involving the frontal bone is unusual, and a limited number of cases have been reported. We present a rare case of a solitary plasmacytoma of the frontal bone manifesting as a forehead lump.