Semih Kivanc Olguner

Objective: To assess the contribution of hematoma burden, anatomical extension, and mass effect to predicting 90-day poor functional outcome alongside clinical characteristics in spontaneous supratentorial intracerebral hemorrhage, and to evaluate temporal model performance. Methods: This single-center retrospective study included 789 patients undergoing CT within six hours of symptom onset: 508 in the development cohort (2018–2022) and 281 in the temporal validation cohort (2023–2025). Poor outcome was defined as a 90-day modified Rankin Scale score of 4–6. Hematoma volume, deep structure involvement, and intraventricular hemorrhage were added to clinical logistic regression models, followed by midline shift. Discrimination and calibration were assessed, with 1000 bootstrap resamples for internal validation. Model coefficients remained unchanged during temporal validation. Secondary analysis replaced absolute shift with the shift/volume ratio while retaining hematoma volume. Results: Poor outcome occurred in 46.1% and 44.5% of patients, respectively. Development AUC increased from 0.798 to 0.846 with volume and extension variables (p < 0.001), then to 0.875 with midline shift (p = 0.014). Hematoma volume, intraventricular hemorrhage, and midline shift remained associated with poor outcome. The adjusted odds ratio per millimeter of shift was 1.17 (95% CI, 1.08–1.28). Optimism-corrected and temporal validation AUCs were 0.856 and 0.854. Model ranking persisted, with generally concordant predicted and observed risks. The association between midline shift and poor outcome persisted in sensitivity analyses addressing surgery or external ventricular drainage, care limitations, and CT timing. The ratio was associated with poor outcome but yielded numerically lower AUCs in both cohorts. Conclusions: The model incorporating all three radiological features showed the highest discrimination among the three models in both cohorts, supporting joint assessment of hematoma burden and mass effect. Multicenter validation and clinical utility assessment remain necessary.

Background/Objectives: Shunt-dependent hydrocephalus remains a major complication following aneurysmal subarachnoid hemorrhage (aSAH). Although several clinical–radiological prediction models have been proposed, the additional contribution of inflammatory biomarkers remains unclear. This study evaluated whether the platelet-to-neutrophil ratio provides additional predictive value beyond established clinical and radiological predictors of shunt-dependent hydrocephalus after aSAH. Materials and Methods: This retrospective single-center cohort study included 418 consecutive patients with aSAH treated using endovascular techniques between 2017 and 2025. Clinical severity parameters, ventricular burden-related radiological findings, and admission hematological variables were analyzed. Independent predictors of shunt-dependent hydrocephalus were identified using multivariable logistic regression analysis. Model performance was assessed using receiver operating characteristic analysis, calibration assessment, sensitivity analyses, and bootstrap internal validation. Results: Shunt-dependent hydrocephalus developed in 75 patients (18%). Lower Glasgow Coma Scale scores, intraventricular hemorrhage, increased Evans index, greater third ventricle width, lower platelet-to-neutrophil ratio, and external ventricular drain requirement were independently associated with shunt dependency. Incorporation of the platelet-to-neutrophil ratio increased the area under the curve from 0.84 (95% CI: 0.79–0.89) to 0.88 (95% CI: 0.84–0.92; p = 0.018). Internal validation demonstrated preserved model performance and calibration. Sensitivity analyses demonstrated similar findings after exclusion of external ventricular drain placement. Conclusions: Platelet-to-neutrophil ratio is independently associated with shunt-dependent hydrocephalus after aSAH and may be considered an additional component of integrated clinical–radiological risk assessment.

Background/Objectives: Stellate ganglion block (SGB) is an interventional technique frequently applied to manage pain associated with sympathetic dysfunction. This study aimed to evaluate the short-term clinical outcomes and tolerability of SGB in patients with different pain phenotypes. Methods: From 1 January 2024 through 1 March 2025, 96 patients who underwent fluoroscopy-guided SGB at a single center were retrospectively analyzed. The Oswestry Disability Index (ODI) was used to assess functional status, the SF-36 was applied to evaluate health-related quality of life, and the Visual Analog Scale (VAS) was employed to measure pain intensity. This study included baseline measurements and follow-up evaluations at 1, 3, and 6 months after the procedure. Results: Statistically significant improvements were observed in VAS, ODI, and SF-36 scores across all pain groups (p < 0.001). The largest median VAS reductions were observed in the migraine (4.0 [3.5–5.0]) and complex regional pain syndrome (CRPS) (3.7 [3.0–4.5]) groups, both exceeding the minimal clinically important difference (MCID). Patients with neuropathic and nociceptive pain showed smaller median reductions (3.4 [2.8–4.0] and 3.0 [2.5–3.8], respectively). The highest proportion of responders (≥50% VAS reduction) was noted in the migraine group (64.3%), while the lowest occurred in the nociceptive group (37.5%). Multivariate analysis identified pain phenotype as the only independent predictor of favorable outcomes, particularly in migraine and CRPS. Minor transient complications occurred in 9.4% of patients, all resolving spontaneously. Conclusions: SGB was well tolerated and associated with significant pain reduction and functional improvement. The observed clinical benefits may reflect mechanisms involving both peripheral and central sympathetic modulation. Larger multicenter prospective studies with extended follow-up are warranted to confirm these findings.

Background/Objectives: Spinal hydatid disease frequently poses significant surgical challenges and leads to severe neurological complications. Despite the development of various surgical techniques, recurrence remains a common issue. The aim of this study was to evaluate the impacts of radical vertebrectomy on recurrence and long-term follow-up outcomes by comparing total en-bloc spondylectomy with conventional laminectomy, decompression, and posterior stabilisation in patients treated at our centre. Methods: This study included 21 patients who underwent surgery for spinal hydatid cysts at our centre between 2001 and 2021. Twelve patients had cystectomy, laminectomy, decompression, and stabilisation, and nine patients had total en-bloc spondylectomy. A single senior surgeon carried out each procedure, selecting the surgical approach based on the presence of vertebral body involvement. All patients received albendazole treatment for six months following surgery. The surgeon who performed the operations followed up all patients clinically and radiologically for at least three years. Results: Seven out of twelve patients (58.3%) who had conventional surgery experienced recurrences, while total en-bloc spondylectomy produced no recurrences (p = 0.004). The recurrent cases had a mean of 2.8 surgical procedures and manifested within 14 months. Although total en-bloc spondylectomy was associated with a longer operative time and greater blood loss, neurological recovery and overall clinical outcomes were comparable between the two groups. The difference in the recurrence rate was statistically significant. Conclusions: Although technically demanding, radical vertebrectomy is shown to provide complete protection against recurrence in appropriately selected patients with spinal hydatid disease in this study. Furthermore, as conservative approaches often require multiple procedures, total en-bloc spondylectomy can be considered an effective treatment for patients with vertebral body involvement.

Background/Objectives: Glioblastoma ranks among the most aggressive brain tumors, with poor prognosis. Currently, there are insufficient data regarding the prognostic value of isocitrate dehydrogenase (IDH) mutation status and inflammatory markers. This study demonstrates the prognostic value of IDH mutation status and preoperative inflammatory markers in glioblastoma. Methods: This single-center retrospective study encompassed 66 glioblastoma patients who had surgical treatment in our institution from January 2020 to March 2022. The patients were categorized into two groups: IDH-mutant (n = 30) and IDH-wild-type (n = 36). We made a comparative assessment of demographic characteristics, clinical parameters, preoperative blood parameters, and survival outcome across the two groups. Statistical analyses included Kaplan–Meier survival curves, ROC analysis, and multivariate Cox regression. Results: The IDH-mutant group demonstrated a significantly lower mean age (53.93 ± 12.00) compared to the wild-type group (62.39 ± 10.12) (p = 0.003). Median overall survival was notably longer in the IDH-mutant group, at 16.0 months, versus 6.5 months in the wild-type group (p = 0.030). An elevated neutrophil/lymphocyte ratio above 3.39 (sensitivity 95.12%, specificity 52.0%) and a platelet/lymphocyte ratio exceeding 136.25 (sensitivity 80.49%, specificity 64.0%) were associated with poor prognosis. Cox regression analysis identified IDH-wild-type status (HR = 2.84, 95% CI: 1.56–5.18) and elevated NLR (HR = 1.84, 95% CI: 1.16–2.92) as independent poor prognostic factors. Conclusions: We show that IDH-wild-type glioblastomal patients have a significantly poorer overall prognosis. In this case, the metrics of preoperative neutrophil/lymphocyte ratio and platelet/lymphocyte ratio seem to be supplied with some value as biomarkers for the expansion of the disease and predicting likely outcomes.

Amaç : Bu deneysel sıçan çalışmasının amacı direk olarak siyatik sinir üzerine topikal uygulanan vancomisin tozun perinöral fibrozis ve kronik inflamasyon gelişimine neden olup olmadığını araştırmaktır. Materyal-metod : Otuz adet erkek Wistar-Albino cins sıçan çalışmaya dahil edilerek intraperitoneal anestezi sonrası uygulanacak doz miktarına göre 10’arlı 3 gruba ayrıldı. Siyatik sinir ekplorasyonu ardından tek doz vankomisin toz verilen 10 sıçan (grup 1), çift doz vankomisin uygulanan 10 sıçan (grup 2) , 10 hayvana ise ilaç verilmeyerek kontrol grubu (grup 3) oluşturuldu. 3 hafta sonra ise sıçanlar sakrifiye edilerek siyatik sinir etrafındaki doku örnekleri alındı ve histopatolojik incelemeye gönderildi. Bulgular : Grup 1 de 1 (%10) hayvanda evre 1 perinöral fibrosis tespit edildi. Diğer 9 (%90) deney hayvanında epidural fibrozis görülmedi. Grup 2 deki 10 deney hayvanından 1 tanesinde (%10) evre 2, 1 tanesinde ise (%10) evre 1 perinöral fibrozis saptandı. Sekiz hayvanda (%80) ise perinöral fibrozis bulgusu saptanmadı. Grup 3 de ise 1 (%10) deney hayvanında evre 1 perinöral fibrozis saptandı. Kronik inflamasyon ise hiçbir deney hayvanında tespit edilmedi. İstatistiksel incelemeler sonucunda 3 grup arasında perinöral fibrozis açısından anlamlı farklılık saptanmadı (p=0.753). Sonuç : Bu deneysel hayvan çalışmasında vankomisin toz uygulanan hastalarda fibrozis gelişiminin gruplar arasında anlamlı farklılık göstermediğini saptadık. Daha büyük katılımlı ve histopatolojik incelemelerin daha detaylı yapılacağı deneysel çalışmalar sonucunda daha objektif sonuçlara varılacağı kanaatindeyiz

Objective : The subaxial cervical pedicle screwing technique shows powerful biomechanical properties for posterior cervical fusion. When applying a pedicle screw using the freehand technique, it is essential to analyse cervical computed tomography and plan the surgery accordingly. Normal cervical computed tomography is usually performed in the supine position, whereas during surgery, the patient lies in a prone position. This fact leads us to suppose that radiological evaluations may yield misleading results. Our study aimed to investigate whether there is any superiority between preoperative preparation on computed tomography performed in the prone position and that performed in the supine position. Methods : This study included 17 patients (132 pedicle screws) who were recently operated on with cervical vertebral computed tomography in the prone position and 17 patients (136 pedicle screws) who were operated on by conventional cervical vertebral computed tomography as the control group. The patients in both groups were compared in terms of age, gender, pathological diagnosis, screw malposition and complications. A screw malposition evaluation was made according to the Gertzbein-Robbins scale. Results : No statistically significant difference was observed between the two groups regarding age, gender and pathological diagnosis. The screw malposition rate (from 11.1% to 6.9%, p<0.05), mean malposition distance (from 2.18 mm to 1.86 mm, p <0.05), and complications statistically significantly decreased in the prone position computed tomography group. Conclusion : Preoperative surgical planning by performing cervical vertebral computed tomography in the prone position reduces screw malposition and complications. Our surgical success increased with a simple modification that can be applied by all clinicians without creating additional radiation exposure or additional costs.