Alper Tabanli

Background/Objectives: Perirolandic brain metastases are challenging to resect because small deviations from the surgical corridor may cause sensorimotor deficits. This study evaluated the stage-specific value and limitations of general-purpose, non-navigated B-mode intraoperative ultrasonography (iUS) with MRI-based frameless neuronavigation in a consecutive surgical cohort of perirolandic metastases. Methods: In this single-center, single-surgeon retrospective case series, 15 consecutive adults underwent microsurgical resection of perirolandic brain metastases using MRI-based frameless neuronavigation and a general-purpose B-mode ultrasound system, without functional mapping or neurophysiological monitoring. Extent of resection was assessed on contrast-enhanced MRI obtained 24 to 36 h after surgery, and post-resection cavity iUS findings were compared descriptively with early postoperative MRI. Results: Gross-total resection was achieved in 13 patients (86.7%). iUS modified intraoperative targeting in 6 of 15 patients: the entry point was repositioned after findings consistent with intraoperative brain shift in 4, and the lesion was localized in interhemispheric corridors in 2. Post-resection iUS suspected residual tissue in 7 of 14 patients, but only 1 corresponded to residual tumor on MRI; a thin remnant on the motor cortex was not identified as suspicious for residual tumor on iUS. A new or worsened motor deficit occurred in 2 patients (13.3%); at follow-up, this was persistent at 20 months in 1 and partially improved in the other. No patient required reoperation, and there was no 30-day mortality. Conclusions: General-purpose B-mode iUS aided exposure confirmation and trajectory refinement but had limited value for excluding thin residual tumor. When functional mapping or neurophysiological monitoring is unavailable, it may provide accessible real-time anatomical guidance; however, because it lacks functional information, it should not be considered an alternative to these functional adjuncts.

Background and Objectives: Ischemia-modified albumin (IMA) has previously been identified as a biomarker for early ischemia, rapidly formed by acidosis and free radical modification of the N-terminus of human serum albumin. This study aimed to compare albumin and IMA levels in blood and cerebrospinal fluid (CSF) from 30 patients with spontaneous subarachnoid hemorrhage (SAH) and 15 patients with normal pressure hydrocephalus (NPH) at a single center between 2021 and 2022. Materials and methods: This prospective study included 30 patients diagnosed with subarachnoid hemorrhage (SAH), confirmed radiologically, who were admitted to the Health Sciences University İzmir Bozyaka Training and Research Hospital and constituted the study group. The control group consisted of 15 patients diagnosed with normal pressure hydrocephalus (NPH) without a history or radiological evidence of subarachnoid hemorrhage or any other intracranial hemorrhagic pathology. In the control group, no pathological findings suggestive of hemorrhage or inflammation were detected in serum or cerebrospinal fluid (CSF) analyses. Blood and CSF samples were collected simultaneously from all participants, and albumin and ischemia-modified albumin (IMA) levels were measured. Serum and CSF albumin and IMA levels were compared between the study and control groups. Results: Of the 30 patients included in the study, 19 (63.3%) were male and 11 (36.7%) were female. The albumin level was lower in the patient group compared to the NPH group (3.8 g/dL [1.8–4.7] vs. 4.3 g/dL [3.2–5.0], respectively, p = 0.008). The serum IMA level was higher in the patient group compared to the NPH group (0.36 ABSU [0.30–0.65] vs. 0.25 ABSU [0.05–0.32], respectively, p = 0.010). The serum IMA level was higher in the vasospasm group compared to the group without vasospasm. Conclusions: In patients with SAH, a condition associated with high morbidity and mortality, modified albumin levels were found to be significantly higher in both CSF and blood compared to the NPH group. IMA may be a potential biomarker associated with SAH and vasospasm; however, further large-scale studies with multivariable analysis and external validation are required to confirm its diagnostic and prognostic utility.

Background and Objectives: Osteoporotic vertebral compression fractures (OVCFs) are a common cause of morbidity in the elderly, often resulting in pain, reduced mobility, and diminished quality of life. Treatment options include conservative management, vertebroplasty (VP), and kyphoplasty (KP). This study aimed to compare the clinical outcomes and complication rates of patients treated with kyphoplasty/vertebroplasty versus conservative methods and identify risk factors associated with the development of new fractures. Materials and Methods: This retrospective cohort study included patients diagnosed with OVCFs who were treated either surgically (KP/VP) or conservatively between January 2020 and January 2025. Inclusion criteria encompassed vertebral height loss on CT, STIR hyperintensity on MRI, and a T-score below −2.5. Patients were followed for at least one year. Clinical evaluations included pain scores (VAS), functional status (ODI), and quality of life assessments. Complications and new fracture rates were recorded. Logistic regression analysis was performed to identify risk factors influencing fracture recurrence. Results: A total of 132 patients were analyzed: 65 in the KP/VP group and 67 in the conservative treatment group. The KP/VP group achieved better postoperative pain results (3.2 ± 1.0 vs. 4.0 ± 1.2) with a significant difference of −0.8 (95% CI: −1.2 to −0.4, p = 0.032) and better mobility results (ODI: 4.5 ± 0.8 vs. 3.9 ± 0.9) with a significant difference of 0.6 (95% CI: 0.3–0.9, p = 0.047) and improved quality of life scores (6.7 ± 1.1 vs. 5.9 ± 1.3) with a significant difference of 0.8 (95% CI: 0.4–1.2, p = 0.041). The incidence of new fractures was similar between groups (15.4% vs. 17.9%, p = 0.678). Overall complication rates were 7.7% in the KP/VP group versus 11.9% in the conservative group (p = 0.435). The results from logistic regression analysis showed that age (adjusted OR: 2.48, 95% CI: 1.20–5.13), low bone mineral density (adjusted OR: 0.31, 95% CI: 0.15–0.63), and cement leakage (adjusted OR: 3.10, 95% CI: 1.21–7.99) were identified as risk factors for new fractures. The study found that outdoor activity (adjusted OR: 0.38, 95% CI: 0.20–0.73) and anti-osteoporosis treatment (adjusted OR: 0.17, 95% CI: 0.04–0.79) acted as protective factors against new fractures. The KP/VP group required half the time to recover from their injuries because they used their braces for 3.0 ± 0.5 months instead of 6.0 ± 1.0 months (p < 0.001). Conclusions: Kyphoplasty and vertebroplasty were more effective than conservative treatment in improving pain, mobility, and quality of life in patients with OVCFs. Although the incidence of new fractures did not differ significantly between groups, surgical treatment demonstrated lower complication rates and significantly faster recovery, as evidenced by reduced brace use duration. These findings support the use of KP/VP as a viable option for managing OVCFs in appropriately selected patients.

A 67-year-old male presented with sudden headache and decreased consciousness, diagnosed as spontaneous subarachnoid hemorrhage (SAH). Imaging revealed an anterior communicating artery (ACoA) aneurysm and congenital absence of the left internal carotid artery (ICA), confirmed by the absence of the carotid canal. The aneurysm was surgically clipped. Postoperative angiography demonstrated that the left anterior and middle cerebral arteries were perfused via collateral flow from the posterior circulation. The patient made a full recovery. Congenital ICA absence is rare but significantly alters cerebral hemodynamics, especially within the circle of Willis, predisposing patients to aneurysm formation. This case underlines the importance of vascular imaging in patients with SAH and highlights the need for urgent diagnosis and intervention in the presence of congenital vascular anomalies.

Objective: To compare the clinical and radiological e!cacy of bone cement volumes injected during unilateral percutaneous balloon kyphoplasty for thoracolumbar vertebral compression fractures. Methods: In this retrospective study, we reviewed data from 96 patients who underwent single-level unilateral kyphoplasty. The patients were categorized into 2 groups based on the cement volume injected: group 1 (cement volume "4 mL, minimum 3 mL; n=48) and group 2(cement volume >4 mL, maximum 6 mL; n=48). The clinical outcomes, as assessed using the Oswestry Disability Index (ODI) and visual analog scale (VAS) scores, were evaluated preoperatively and then at the final follow-up 1 month postoperatively. The vertebral corpus height at the fracture level was measured at the anterior, middle, and posterior regions through sagittal computed tomography scanning. Results: The mean age of the patients was 64.2 years in group 1 and 63.8 years in group 2. In group 1, the mean anterior vertebral height increased from 19.0 ± 3.3 mm preoperatively to 19.9 ± 3.2 mm postoperatively, whereas in group 2, it increased from 17.9 ± 3.8 mm to 19.6 ± 3.7 mm, respectively. The middle vertebral heights were 15.4 ± 2.5 mm preoperatively and 16.9 ± 2.8 mm postoperatively in group 1 and 16.0 ± 3.6 mm and 17.5 ± 3.2 mm, respectively, in group 2. Both groups exhibited significant improvements in ODI and VAS scores, with no significant di#erence between the groups. A statistically significant increase was recorded within each group for the anterior, middle, and posterior vertebral heights. However, a significantly greater increase was noted in the anterior height in group 2 compared to that in group 1 (P < .05). Conclusion: Unilateral kyphoplasty is an e#ective procedure for managing painful vertebral compression fractures. The greatest loss of vertebral height occurred in the middle column, which also exhibited the greatest potential for restoration. Thus, a higher cement volume facilitated greater restoration of the anterior column height. Cite this article as: Benek HB, Ulgen T, Tabanlı A, Ak C, Akcay E, Yilmaz H. E!cacy of bone cement volume in unilateral kyphoplasty of thoracolumbar compression fractures: A clinical comparative study. Acta Orthop Traumatol Turc., 2025;59(1):63-68.

BACKGROUND The main concern regarding lung-protective ventilation strategies during neurosurgery is the reduction in venous return and increase in cerebral blood flow when using high positive end-expiratory pressure (PEEP). This study aimed to evaluate and compare the changes in regional cerebral oxygen saturations (rSO2) during the use of 5 cmH₂O and 10 cmH₂O PEEP in patients undergoing craniotomy for tumor resection. MATERIAL AND METHODS The study was designed as a prospective, single-blind randomized controlled study. Patients aged between 18 and 70 years, scheduled for an elective craniotomy for tumor resection, were divided into 2 groups: 5 cmH₂O PEEP (Group Low PEEP) and 10 cmH₂O PEEP (Group High PEEP). The PEEP was applied during general anesthesia, for controlled mechanical ventilation. The main outcome was the measurement of rSO2 before dura opening. Changes in rSO₂, hemodynamic parameters, and peripheral oxygen saturation (SpO₂) during different periods of surgery were compared between the groups. RESULTS Sixty-four patients were included. There were no significant differences between the 2 groups regarding demographic data. Mean arterial blood pressure and changes in SpO₂ were statistically similar in all periods between the groups (P=0.141 and P=0.081). When compared with the baseline value, SpO₂ increased significantly at all measurement times (P<0.05). No difference was observed in rSO₂ values compared with baseline rSO₂ values between the groups (P=0.218). CONCLUSIONS PEEP at the level of 10 cmH₂O can be safely applied during craniotomy without altering hemodynamics, and without causing a decrease in rSO₂.

Multidisciplinary Management of Patients with Brain Abscesses: A Retrospective Analysis - Cyprus Journal of Medical Sciences

Purpose Tethered cord syndrome (TCS) typically presents with urologic symptoms and abnormal imaging findings. However, some patients present with normal conus medullaris level and filum terminale appearance on MRI. This research seeks to assess the intended surgical results in this particular group of TCS patients who do not present with urologic complaints, under the premise that the surgical approach goes a long way in preventing the onset of urologic abnormalities. Methods This retrospective study included 59 operated patients with tethered cord syndrome who had a normal level terminating conus medullaris and a normal looking filum terminale without urologic symptoms. Of these patients, 38 were female and 21 were male. All patients underwent somatosensory-evoked potentials (SSEPs), and magnetic resonance imaging (MRI). The surgical technique used was flavotomy, which involves cutting the filum terminale without performing a laminectomy. Results The study population had a mean age of 22.5 years (SD = 13.2). During the mean postoperative follow-up period of 2.5 years, none of the patients developed urinary incontinence. Preoperative SSEP abnormalities included conduction block in 39 patients (66.1%), low amplitude in 12 patients (20.3%), and delayed N22 wave latency in 8 patients (13.5%). The surgical procedures were completed without morbidity or mortality, and all patients showed significant postoperative improvement in SSEP parameters. Conclusion Our results indicate that even though the filum terminale might have a normal looking MRI, TCS can also occur due to some potential microscopic or structural abnormality. The study proves SSEP to be useful in TCS diagnosis and it also proposes that if surgery is done early before any urologic complaints arise, chances of their onset will be minimized. Such findings support the view that surgical measures should be entertained in symptomatic patients with abnormal SSEP but normal MRI.

Hemorrhagic Risk in Vestibular Schwannoma Surgeries: Insights and Implications - Article abstract #946583