Baran Can Alpergin

Background: Differentiating tumor tissue from normal brain parenchyma during glial tumor resection can be highly challenging. In situations where surgical navigation systems are unavailable and the use of neuromonitoring is limited due to restricted resources, there is a need for affordable and practical alternatives.Aim: we describe a simple technique for delineating the resection margins of low-grade gliomas using bone wax as an intra-cavitary marker in conjunction with magnetic resonance imaging (MRI).Materials and Methods: During tumor resection, small sterile fragments of bone wax were placed within the resection cavity to serve as intra-cavitary fiducial markers. MRI was subsequently performed, allowing real-time visualization of the bone wax positions relative to the surrounding brain parenchyma.Results: Bone wax fiducials provided clear reference points for delineating tumor boundaries and assessing the extent of resection. Surgical margins were determined based on the spatial relationship between the bone wax markers and the residual enhancing tissue, facilitating accurate tumor removal in the absence of advanced neuronavigation systems. Tumor resection was carried out with careful preservation of eloquent cortical and subcortical regions, as identified by preoperative imaging and intraoperative anatomical landmarks.Conclusion: Bone wax represents a practical and cost-effective alternative in resource-limited settings, providing a simple method to minimize navigation system inaccuracies that may occur during surgery. It can be safely and effectively used in centers with limited technical resources.

BACKGROUND AND OBJECTIVES: Robotic surgery systems are commonly used in many surgical fields but currently have limited adoption in neurosurgery. The goal for this work was to share our experience with the da Vinci Xi surgical robot for neurosurgical practice. METHODS: Our senior surgeon (U. E.) underwent robotic surgery training followed by simulation training. Five patients then underwent robotic surgery performed by the surgeon; pathologies included clivus chordoma, odontoid metastatic mass, peroneal neuropathy, and arachnoid cyst. Clinical data, demographic details, and follow-up outcomes were analyzed. RESULTS: Of the 5 patients (2 female, 3 male; mean age, 43 years), 2 had a clivus chordoma, 1 had an odontoid metastatic mass, 1 had peroneal neuropathy, and 1 had an arachnoid cyst. No intraoperative or postoperative neurological deficits or complications were observed. All 5 of the patients had a favorable outcome. CONCLUSION: Robotic systems can offer clear advantages over traditional neurosurgery, particularly for transoral resection and intracranial cyst fenestration. However, practical training is essential for effectively integrating these systems into routine neurosurgical practice. The case series presented here reveals the feasibility of robotic neurosurgery and the need for further evaluation of this technology.

Background and purpose – Neurosurgical approaches in Sylvian arachnoid cysts include microsurgery, endoscopy, and shunting. Yet, their relative safety and efficacy is still under debate. This retrospective study evaluated 36 pediatric patients with Sylvian arachnoid cysts and treated with different surgical types to contribute to global data. Methods – The study included 24, 8, and 4 patients receiving endoscopic, microsurgical, and shunt surgeries, respectively. Preoperative and postoperative assessments included the patients’ demographics and symptoms, cyst size and type, psychomotor status, length of hospital stay, and complications with a mean follow-up of 37.3 months. Results – All types of surgeries alleviated headaches and seizures in most of the patients. Shunt operations led to the highest reduction in cyst size in the early postoperative period and relieved cranial palsy in all patients. Microsurgery achieved greater healing regarding hemiparesis and seizures, and reduced cyst size more effectively in the early postoperative period than endoscopy. Complication rates were similar between the endoscopy and microsurgery groups. Conclusion – Arachnoid cyst surgery is efficient and relatively safe. The higher efficacy of microsurgery may be associated with the lesser chronic presence of cysts in this group rather than its technical superiority. Endoscopic surgery is challenging, yet it may be advocated to avoid craniotomy and shunt complications. Surgical-type decisions for arachnoid cysts should be patient-tailored based on careful preoperative clinical and radiological examinations.

Objective To show the change in the anterior clinoid process (ACP) morphology in children with advancing age. Methods Radiologic images of 180 subjects aged 1 to 18 years were included in the work. The length (ACPL), width (ACPW), and angle (ACPA) of ACP, and the distance (DisACPOS) of ACP to the optic strut (OS) were measured. ACP pneumatization and OS location types were noted. Results ACPL, ACPW, and ACPA, and DisACPOS were measured as 12.34 ± 2.29 mm, 4.52 ± 1.03 mm, 26.26 ± 4.30°, and 5.10 ± 1.12 mm, respectively. ACP pneumatization was identified in 30 (8.3%) sides. Four types regarding its pneumatization were observed: Type 0 in 91.7% out of 360 sides, Type 1 in 2.5%, Type 2 in 3.6%, and Type 3 in 2.2%. Three configurations regarding OS location types were observed as follows: Type C in 3.6% out of 360 sides, Type D in 51.7%, and Type E in 44.7%. Linear function was calculated as y = 9.377 + 0.312 × age for ACPL, y = 3.716 + 0.084 × age for ACPW, and y = 3.808 + 0.136 × age for DisACPOS. Conclusion ACPL, ACPW, and DisACPOS increased, but ACPA did not vary with advancing ages in children. OS was located more posteriorly in children compared with adults. Most of ACP pneumatization was seen after prepubescent period.

Numerous studies have been conducted regarding vertebral restoration, development of kyphotic deformity, and pain control following balloon kyphoplasty. However, there is no consensus regarding the ideal time to perform kyphoplasty. Herein, we aimed to compare the results of treatment of different vertebral levels following early or late kyphoplasty. Between 2017 and 2022, 283 patients with single-level osteoporotic vertebral fractures were retrospectively reviewed. Patients in whom visual analog scale (VAS) values were recorded, and osteoporosis tests performed were included in the study. Traumatic single-level fractures in patients with osteoporosis who were aged > 60 years were included. Patients with a history of malignancy, previous spinal surgery, or neurological deficits were excluded. A total of 100 patients met the inclusion criteria. A total of 50 patients underwent kyphoplasty within 3 days of sustaining the fracture (Group 1), and 50 patients underwent kyphoplasty more than 3 days after sustaining the fracture (Group 2). Groups A, B, and C included fractures at the T7–T11 levels, T12–L1 levels (thoracolumbar junction), and L2–L5 levels, respectively. These groups were compared among themselves. Bilateral balloon kyphoplasty was performed under sedation in the prone position. Preoperative and postoperative VAS scores, anterior vertebral heights, and kyphotic angles (KAs) were measured and recorded. The vertebral segments that underwent early and late kyphoplasty were also compared among themselves. In all the patients who underwent early or late kyphoplasty, there was a significant decrease in the KA and a significant increase in vertebral heights during the early postoperative period (p < 0.001). There was no significant change in the vertebral heights and KA between the early and late postoperative periods (p = 0.780). Early kyphoplasty demonstrated better pain control with a greater improvement in VAS score (p < 0.001) than late kyphoplasty. Kyphoplasty plays an important role in reducing pain and ensuring early mobilization in older patients. In our study, the improvements in both symptoms and radiological features are concrete evidence in favor of performing early kyphoplasty.

Objective: In the elderly population, subdural hematoma represents a significant cause of morbidity and mortality. The surgical and anesthesia techniques for managing this condition have progressively evolved. Unlike numerous studies that compare chronic cases managed under general anesthesia and sedation, our study uniquely focuses on acute subdural hematoma cases. Material and Method: From 2020 to 2024, a retrospective study reviewed 54 patients aged 65 and older who underwent surgery for acute subdural hematoma. The patients were categorized into two groups: sedation (n=26) and general anesthesia (n=28). Data on surgical duration, hospital and intensive care unit stays, and mortality rates were collected from hospital archives. The general anesthesia group received midazolam, fentanyl, propofol, and rocuronium, while the sedation group received midazolam, fentanyl, and propofol. Subdural drains were universally placed and removed after postoperative brain computed tomography. Results: The mortality rate was significantly lower in the sedation group compared to the general anesthesia group (p=0.024). Surgical duration was shorter in the sedation group (p

Aim: Cervical discectomy followed by cage placement for fusion is nowadays a commonly used method for the treatment of degenerative cervical spine diseases. One of the complications that can be observed during postoperative follow-up is cervical cage subsidence. At this point, it is investigated in this study the relationship between the loss of endplate brightness observed on early postoperative cervical radiographs and the development of cervical cage subsidence during follow-up. Methods: 100 patients who underwent single-level cervical disc herniation surgery between 2013 and 2023 were selected. The patients were divided into two groups based on the presence or absence of cage subsidence in cervical radiographs taken at the 60-day postoperative follow-up. In all patients included in the study, the presence of endplate brightness loss in the cervical radiographs taken within the day 1 of post-surgery period in the vertebrae adjacent to the cage was evaluated and compared between groups. Results: Cage subsidence was detected in 11 patients (11%), while it was not observed in 89 patients (89%). Among the 11 patients with cage subsidence, endplate brightness loss was identified in 8 patients (72.7%), whereas it was found in 10 patients (11.2%) among the 89 patients without cage subsidence. These results indicate a significant relationship between the loss of endplate brightness observed on early radiographs and the occurrence of cervical cage subsidence during later follow-up (p

Purpose: The aim of this study is to evaluate the use of flavum-preserving surgeries in lumbar disc herniation surgery, compare their clinical outcomes with standard microdiscectomy techniques, and demonstrate the transflaval microdiscectomy technique. Material and methods: Between 2020 and 2023, a total of 48 patients who underwent transflaval microdiscectomy and 48 patients who underwent standard microdiscectomy at a single center were included in the study. Epidemiologic characteristics of the groups were described, and from the preoperative and postoperative 12 months visual analoge scale scores for leg pain (LPVAS) and back pain (BPVAS) were retrospectively analyzed. Results: There is no significant difference between the groups in preoperative mean LPVAS scores (p=0.474) and there is no significant difference between the groups in postoperative mean LPVAS scores (p=0.598). There is no significant difference between the groups in preoperative mean BPVAS scores (p=0.608). However there is a significant difference between the groups in postoperative mean BPVAS scores (p<0.001) This result indicates transflaval microdiscectomy surgery show better clinical outcomes in follow-up in terms of back pain compared to standard microdiscectomy surgery. In group 1 (transflaval group), recurrence occurred in 3 patients, while in Group 2 (microdiscectomy), 4 patients experienced recurrence. During the reoperation of patients with recurrence, none of the patients in Group 1 exhibited epidural fibrosis, whereas all patients in Group 2 showed signs of epidural fibrosis. Additionally, during reoperation, no patient in Group 1 experienced dural injury, while dural injury occurred in 2 patients in Group 2. Conclusion: Preserving the ligamentum flavum structure and minimizing its damage during lumbar microdiscectomy surgery results in less axial pain and improved clinical outcomes during follow-ups.