Mustafa Umut Etli

Objectives: This study aimed to evaluate the utility of MRI-based morphometric and qualitative parameters in identifying patients with suspected normal pressure hydrocephalus (NPH) associated with shunt surgery selection following clinical and lumbar puncture evaluation. Methods: We retrospectively analyzed 134 participants: 84 symptomatic patients evaluated for suspected NPH and 50 age-matched controls with normal brain MRI findings. Symptomatic patients were categorized according to subsequent clinical management following lumbar puncture evaluation into those who underwent shunt surgery (Shunt group) and those who received conservative management (Conservative group). The Evans index, fronto-occipital horn ratio (FOHR), bicaudate index, callosal angle, ventricular measurements, and disproportionately enlarged subarachnoid space hydrocephalus (DESH) components were analyzed. The discriminatory performance of MRI parameters for shunt surgery selection was assessed using ROC analysis; independent predictors of shunt surgery selection were determined using logistic regression. Results: Although conventional ventricular indices and ventricular dimensions were significantly greater in symptomatic patients than in the control group (p < 0.001), baseline continuous MRI measurements did not significantly differ between the Shunt and Conservative groups (p > 0.05). Callosal angle demonstrated no discriminatory value for shunt surgery selection. In univariate analyses, an Evans Index > 0.36, a bicaudate index > 0.23, and a DESH score > 2 were associated with shunt surgery selection. High-convexity tightness and an Evans Index > 0.36 differed significantly between groups and remained independently associated with shunt surgery selection in multivariable analysis. Conclusions: Ventricular width-based indices alone appear insufficient for identifying patients selected for shunt surgery among individuals evaluated for suspected NPH. Both qualitative and quantitative MRI features, particularly high-convexity tightness and an Evans Index > 0.36, were independently associated with shunt surgery selection following routine clinical assessment. Integrating multimodal imaging parameters with clinical evaluation may provide a more reliable approach for identifying patients who are ultimately selected for shunt surgery following lumbar puncture assessment.

Lumbar degenerative disc disease (LDDD) is characterized by persistent inflammation and extracellular matrix degradation. Emerging as main controllers in its pathogenesis are microRNAs (miRNAs) and proinflammatory cytokines. Through the JAK/STAT signalling pathway, HSA-miR-186-5p has been linked to modulating cytokine expression, including interleukin-2 (IL-2). The aim is to find the expression levels of IL-2 and HSA-miR-186-5p in LDDDpatients and investigate their possible correlation with disease degree. 110 LDDD patients and 17 healthy controls wereincluded. ELISA measured serum IL-2 concentrations, and RT-qPCRestimated miR-186-5p levels. The Oswestry Disability Index (ODI) guidedpatients into five subgroups (G1–G5). One-way ANOVA and correlationanalysis were applied in statistical comparisons. LDDD patients had notably higher IL-2 levels than controls ( p p < 0.001), with G1and G5 having the lowest levels found. Across groups, an inverse trend in IL-2 and miR-186-5p expression was noted. Results imply a dysregulated interaction between HSA-miR-186-5p and IL-2 in LDDD. Particularly in early and moderate stages ofdisease, miR-186-5p downregulation could help to explain increased IL-2-mediated inflammation. These biomarkers could provide information ondisease activity and present targets for new treatments.

Background: Intraoperative cytological consultation (IOC) is a practical, rapid, and reliable method for evaluating central nervous system (CNS) tumors, enhancing the neurosurgical oncological approach. While some studies have used Papanicolaou (Pap) staining for diagnosis, its exact contribution in comparison to the rapid hematoxylin and eosin (HE) staining technique and its cytological staining characteristics remains to be fully clarified. Method: During 12 months, this prospective study examined and contrasted the final histopathological section diagnoses of 161 specimens collected from 146 consecutive patients who received intraoperative touch‐imprint cytology (TIC) and squash smear preparation (SP) techniques, using both HE and Pap staining methods. Results: The diagnostic accuracy of TIC, relative to the final integrated histopathological diagnosis, was 85.1%. Although data for frozen sections were not separately quantified, TIC remains a rapid, reliable, and practical method for intraoperative evaluation. The evaluation of CNS lesions is best achieved by histopathology, which is considered the gold standard. The most common neoplasms were glioblastoma IDH‐wild type, metastatic cancers, pituitary neuroendocrine tumor (adenoma), and meningiomas. Kappa statistics between Pap and HE staining demonstrated very good overall agreement (kappa 0.9–1, p < 0.01) across all assessed cytological features, with the highest concordance observed for nuclear details, artifacts, mitotic background, necrosis, and cytoplasmic details. Although the Wilcoxon rank‐sum test indicated small but statistically significant differences in the median scores for nuclear details and artifacts, these differences reflect minor quantitative variations and do not affect the very good overall agreement between the two staining methods. Conclusion: Intracranial TIC and SP specimens stained with both HE and Pap demonstrated excellent diagnostic performance, characterized by high sensitivity and specificity. The combined use of Pap staining alongside HE provides a reliable and effective alternative to traditional cytological staining methods.

Objective The posterolateral transforaminal approach, which has been used to treat foraminal and far-lateral disc herniations for a long time, has also become a reliable method for accessing spinal tumours. This method takes advantage of the neural foramen’s natural anatomical pathway, which allows for the removal of the tumour with minimal damage to the surrounding osseoligamentous structures. This study examines 10 years of spinal tumours treated with this method by a single experienced neurosurgeon. Methods A total of 40 patients who underwent 40 surgeries between 2008 and 2018 were reviewed. We examined the patients’ demographics, the location of the tumour, the histopathological diagnosis, the extent of the resection, and the surgical outcomes. The lesions were located in the lumbar region, and the same posterolateral transforaminal technique was employed for all surgeries. Results The cohort included 21 men and 19 women in the group, and the average age was 49.2 years (range: 14–75). Schwannomas (n = 27) and metastatic tumors (n = 9) were the most common histopathologies. In 38 cases, the whole tumor was removed, and in 2 cases, only part of it was removed. The method made it possible to safely and effectively reach the lateral and anterior spinal canal compartments, with few complications and good results after surgery. Conclusion The posterolateral transforaminal approach represents a reliable, minimally invasive corridor for the surgical management of selected spinal tumours. Our decade-long, single-surgeon experience supports its utility in achieving adequate resection with minimal morbidity, especially in tumours localised to the far lateral and foraminal zones of the spine.

Background The treatment of Chiari malformations generally consists of posterior fossa decompression. C1 laminectomy is required in selected cases. However, cases of iatrogenic anterior arch fractures at C1 without high-energy trauma have been reported. Developing theoretical models of atlas C1 bones that have undergone a laminectomy can help researchers identify the regions where fractures may occur as a result of sudden loads. Methods In this study, we created a detailed three-dimensional solid finite element model of the human atlas bone (C1) using geometric data. The loadings of the laminectomy dimension were evaluated on the basis of three groups. Group I comprised atlas bones that had not undergone a laminectomy. For Group II, the lateral border of the laminectomy was determined as the projection of the lateral mass medial border on the lamina. For Group III, the bilateral sulcus arteriosus was determined as the border for the lateral border of the laminectomy. The analysis results, which are in good agreement with those of previous reports, showed high concentrations of localized stress in the anterior and posterior arches of the atlas bone. Results The analysis results showed that the stress increased in the laminectomy models. The maximum stress observed was consistent with the clinical observations of fracture sites in previous studies. Conclusion In the treatment of patients with Chiari malformations, C1 laminectomy is often required. The width of this laminectomy can lead to iatrogenic anterior arch fractures. This is the first study to evaluate C1 laminectomy width using finite element modeling.