Ali Imran Ozmarasali

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Intraoperative ultrasonography (IoUSG) is an essential real-time imaging tool in neurosurgical practice. However, a physical mismatch between standard probe dimensions and narrow craniotomy windows often hinders its effectiveness. We present a practical and cost-effective "balloon technique" using a saline-filled sterile surgical glove to establish an acoustic bridge. A 61-year-old male with a metastatic brain lesion in the right frontal region underwent a 3x3.5 cm crani-otomy, where a standard 4 cm wide probe exceeded the bone margins. By utilizing a saline-filled interface, we successful-ly achieved high-resolution visualization and total resection without enlarging the craniotomy. This technique provides real-time feedback and brain-shift compensation while maintaining the principles of minimally invasive surgery, offering a superior alternative to costly and time-consuming intraoperative imaging modalities.

Recurrent lumbar disc herniation remains a prominent clinical challenge following microdiscectomy, particularly at the L5–S1 level, which has distinct biomechanical characteristics. While various radiological and clinical predictors have been proposed, the influence of surgical laterality has not been adequately explored. This study aimed to identify independent predictors of recurrence following L5–S1 microdiscectomy, with a specific focus on surgical laterality. This retrospective cohort study included patients who underwent primary L5–S1 microdiscectomy at a single center with a minimum follow-up of 12 months. Recurrence was defined as same-level, same-side herniation confirmed by imaging and clinical findings. Demographic, clinical, and radiological parameters—including facet tropism, disc height index, Modic changes, and multifidus morphology—were analyzed. Recurrence-free survival was assessed using Kaplan–Meier analysis, and independent predictors were identified through Cox proportional hazards regression. Patients with recurrence were significantly older and had higher rates of preoperative neurological deficits and systemic comorbidities. Radiological parameters showed no significant association with recurrence. In multivariable Cox regression analysis, left-sided surgery emerged as the strongest independent predictor, associated with a 3.5-fold increased hazard of recurrence (aHR: 3.506; 95% CI: 1.537–7.999; p = 0.003). Systemic comorbidities also independently increased recurrence risk (aHR: 2.051; 95% CI: 1.000–4.208; p = 0.050). Kaplan–Meier analysis demonstrated significantly shorter recurrence-free survival in patients undergoing left-sided procedures. Recurrence after L5–S1 microdiscectomy appears to be driven more by surgical and systemic factors than by conventional radiological parameters. Surgical laterality, particularly left-sided procedures, represents a novel and significant predictor of recurrence. These findings highlight the potential role of technical and patient-related factors in surgical outcomes.

Background: Hutchinson–Gilford progeria syndrome (HGPS) is an exceedingly rare genetic disorder characterized by accelerated aging and profound vascular fragility. While cerebrovascular accidents are common in this population, traumatic epidural hematomas (EDH) are clinical rarities, with only two pediatric cases previously documented. Currently, it is estimated that fewer than 200 children with HGPS are living worldwide. The primary objective of this report is to present a comprehensive multidisciplinary management strategy for traumatic EDH in a 15-year-old HGPS patient, highlighting the critical interplay between progerin-induced vascular stiffening, reduced intracranial compliance, and the formidable anesthetic challenges encountered in the oldest reported survivor of this pathology. Case presentation: A 15-year-old female with HGPS presented with a right frontoparietal EDH following a ground-level fall. Initial Glasgow Coma Scale (GCS) was 14 but declined to 12 within 4 h. Cranial computed tomography (CT) revealed a large EDH measuring 22 mm at maximum thickness, causing a 6 mm midline shift. Due to severe glottic sclerosis and anatomical distortion, multiple orotracheal and fiberoptic (2.8 mm) intubation attempts failed. An emergency percutaneous tracheostomy was performed to secure the airway. Intraoperative findings revealed active bleeding from a coronal suture diastasis, which was managed with bone wax and dural tenting sutures. The patient achieved full neurological recovery and was discharged on postoperative day 10. Conclusion: Managing HGPS patients requires a high index of clinical suspicion for intracranial injury even after minor trauma, as progerin-induced vasculopathy accelerates hematoma expansion. Standard airway techniques can fail due to progressive laryngeal changes, necessitating early consideration of surgical airways. Prompt multidisciplinary intervention and meticulous neurosurgical technique are essential to mitigate risks associated with extreme vascular fragility and complex anatomy in this high-risk population.

Thoracolumbar junction fractures (TLJF) are critical spinal injuries frequently associated with neurological deficits and internal organ trauma. This retrospective study evaluated 21 adult patients with TLJF who underwent posterior segmental instrumentation between May 2022 and September 2024. Demographic features, trauma mechanisms, neurological status, fracture classifications, and surgical outcomes were analyzed. Laminectomy was performed in 14 patients with significant canal compromise, while short-segment posterior instrumentation was preferred in cases with intact posterior elements. During follow-up, most patients showed significant pain reduction and neurological improvement. Early surgical decompression and stabilization in neurologically compromised patients were associated with better clinical outcomes. Posterior segmental instrumentation remains a reliable treatment method, though long-term studies comparing short- and long-segment stabilization are needed.

A bstract: Ventriculoperitoneal shunt surgery is the primary treatment for hydrocephalus; however, while common complications include infection and dysfunction, shunt-related acute abdomen syndrome due to catheter knotting is exceedingly rare, with fewer than 30 cases reported in the literature. We present a 9-year-old male with congenital hydrocephalus and a history of neonatal surgery for esophageal atresia and Nissen fundoplication who, despite having a stable neurological course for 8 years, suffered from multiple hospitalizations due to nonspecific gastrointestinal symptoms. He eventually presented with acute nausea, vomiting, and abdominal distension, where radiography revealed distal shunt knotting and acute ileus. Emergency laparotomy confirmed a small bowel volvulus caused by the knotted catheter, and following externalization, the patient was successfully treated with a ventriculoatrial shunt. Based on our clinical observations and literature review, we identified that knotting occurs at intestinal “corner points” where chronic peristaltic movements force redundant catheter lengths to rotate and eventually self-entangle. To overcome the limitations of 2D imaging and improve diagnostic accuracy, we emphasize the potential of developing three-dimensional computed tomography reconstruction techniques, similar to those used in aneurysm surgery, to better visualize the spatial orientation of the catheter. We conclude that managing distal catheter length and maintaining a high clinical suspicion regarding the “neurologically silent phase” are the cornerstones of preventing such life-threatening complications, particularly in patients with complex abdominal histories.

Background: Acrania, also known as acalvaria, is an extremely rare congenital malformation characterized by the absence of calvarial bone structures and defects in the associated muscles and sometimes dural structures, while the skull base and facial bone structure are normal. Case presentation: We present the case of a baby born vaginally at 38 weeks of gestation to a 31-year-old mother with an Apgar score of 9–10. Prenatal tests had identified the risk of severe congenital malformation, but the mother refused the option of pregnancy termination. The baby was born with a severe scalp defect and external herniation of immature brain tissue. On the 9th postnatal day, the immature brain tissue was excised, and the defective scalp was repaired. Following the development of hydrocephalus during follow-up, a ventriculoperitoneal shunt was placed at 5 months. The patient remains under uneventful outpatient follow-up at 6 years of age, with persistent neuromotor developmental delay. Conclusions: Acrania was previously known to be a pathology incompatible with life, but the number of survivors is increasing now owing to advancements in medical interventions. Further medical research on this topic will help uncover more information regarding the pathophysiology and treatment of this disease.