Hidayet Safak Cine

Delayed cerebral ischemia(DCI) is a major contributor to poor outcomes after aneurysmal subarachnoid hemorrhage(SAH), primarily due to symptomatic vasospasm. Accurate early risk stratification is essential for optimizing monitoring and treatment. Two commonly used predictors are the World Federation of Neurosurgical Societies(WFNS) clinical grade and the modified Fisher radiographic grade. We assessed whether the simple arithmetic sum of these two scores—termed the “Plus score”—could improve the prediction of DCI and mortality. We retrospectively reviewed the consecutive patients treated with surgical clipping at a single tertiary center from 2021 to 2025. Inclusion required angiographically confirmed aneurysmal hemorrhage, clipping within 72 h, and ≥ 6 months of follow-up. DCI was defined as a new neurological deterioration between post-SAH day 3–15, excluding the other causes. Logistic regression and receiver operating characteristic(ROC) analysis were used to compare the predictive performance of the WFNS grade, modified Fisher grade, and Plus score. Fifty-nine patients (mean age 53 ± 14 years; 52% female) were included. DCI occurred in 32 patients(54%), and in-hospital mortality was 16.9%. The mean Plus score was significantly higher in patients with DCI than those without, and higher in non-survivors than survivors. The Plus score showed superior predictive value for DCI (AUC = 0.748; cutoff ≥ 4.5: sensitivity = 84.4%, specificity = 55.2%) compared to WFNS (AUC = 0.704) and modified Fisher (AUC = 0.703) scores. For mortality prediction, the Plus score had an AUC of 0.870. The Plus score, combining neurological and radiographic severity into a single value, offers improved risk prediction for DCI and moderate accuracy for mortality. Its simplicity and clinical accessibility make it a valuable bedside tool for early stratification and targeted care in patients with aneurysmal subarachnoid hemorrhage. Graphical Abstract

Amaç: Travmatik beyin hasarı (TBH), sekonder nöronal hasarın temel aracısı olarak tanımlanan interlökin-1 beta’nın (IL-1β) rol aldığı karmaşık inflamatuvar kaskadları tetikler. IL-1β’nin nöroenflamasyondaki rolü iyi bilinmesine rağmen, periferik dolaşımdaki dinamik profili yeterince karakterize edilmemiştir. Bu çalışmada, ratlarda deneysel TBI sonrası belirli zaman aralıklarında serum IL-1β düzeylerinin değerlendirilmesi ile bu biyobelirtecin potansiyelinin ve terapötik öneminin araştırılması amaçlanmıştır. Gereç ve Yöntemler: Toplam 40 erişkin erkek Sprague-Dawley sıçan rastgele beş gruba (n=8/grup) ayrıldı: bir sham grubu ve travmadan sonra 1, 6, 24 ve 72. saatlere karşılık gelen dört travma grubu. Orta dereceli TBH, Marmarou ağırlık düşürme modeli kullanılarak oluşturuldu (2 metre yükseklikten bırakılan 450 gramlık bir ağırlık ile). Serum IL-1β konsantrasyonları ELISA yöntemi ile ölçüldü ve istatistiksel karşılaştırmalar tek yönlü ANOVA ve Tukey post-hoc testi ile yapıldı. Bulgular: Sham grubunda serum IL-1β iki fazlı bir eğilim gösterdi: 6. saatte başlangıçta düşüş, 72. saatte ise kısmi toparlanma. Travma grubunda ise dinamik bir patern izlendi: IL-1β 6. saatte azaldı (p=0.0356), 24. saatte anlamlı düzeyde yükseliş gösterdi (p=0.0004, 6. saat ile karşılaştırıldığında) ve 72. saatte tekrar azaldı. Gruplar arası karşılaştırmalarda ise, travma grubunda 24. saatte IL-1β düzeylerinin sham grubuna göre anlamlı şekilde yüksek olduğu saptandı (p=0.0157). Sonuç: Bulgularımız, TBH sonrası serum IL-1β’nın zamana bağlı düzenlenmiş bir ekspresyon paterni sergilediğini ve 24. saatteki yükselişin terapötik hedefleme için potansiyel bir pencere olabileceğini göstermektedir. IL-1β, post-travmatik inflamasyonun izlenmesinde minimal invaziv bir biyobelirteç olarak kullanılabilir, ancak fonksiyonel sonuçlar ve santral doku düzeyleri ile korelasyonunun da araştırılması gerekmektedir.

Objective: We aimed to elucidate the histopathological pre-diagnosis of cranial gliomas with magnetic resonance imaging (MRI) techniques in gliomas. Method: ...

Background: This study aimed to evaluate the diagnostic effectiveness of radionuclide scintigraphy (RS) in detecting lumboperitoneal shunt (LPS) obstructions in patients with idiopathic normal pressure hydrocephalus (iNPH) and idiopathic intracranial hypertension (IIH). Methods: We conducted a retrospective analysis of 44 patients who underwent LPS surgery between 2010 and 2020. Twenty-one patients were diagnosed with iNPH and 23 with IIH. Clinical symptoms, including gait disturbances, cognitive impairment, and urinary dysfunction for iNPH, and headaches and vision loss for IIH, were evaluated. Preoperative computed tomography/magnetic resonance imaging (MRI) scans assessed hydrocephalus indicators, and cerebrospinal fluid (CSF) opening pressure was measured through lumbar puncture. RS was performed using technetium-99m-diethylenetriaminepentaacetic acid, and findings were compared with surgical outcomes. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and concordance (kappa coefficient) were calculated to evaluate the diagnostic accuracy of RS. Results: Of the 44 patients, 18 (40.9%) demonstrated total obstruction, 17 (38.6%) showed partial obstruction, and 9 (20.5%) had no obstruction on RS. All patients with total obstruction confirmed by RS had corresponding findings during surgery (PPV 100%). However, 10 of the 19 patients with partial or no obstruction on RS were found to have obstruction during surgery (NPV 47%). The kappa coefficient for total obstruction was 0.467 (P = 0.001), indicating good concordance between RS and surgical outcomes. Patients with lower CSF pressure, particularly those with iNPH, were more likely to experience false-negative RS results. Conclusion: RS is a reliable tool for detecting total LPS obstructions, but its sensitivity for partial obstructions is limited. Extending imaging periods or integrating additional diagnostic tools such as MRI may improve detection accuracy, particularly in cases with low CSF pressure. Combining RS with clinical evaluations can reduce unnecessary shunt revisions and improve patient outcomes.

Objetivo: Nos propusimos dilucidar el pre-diagnóstico histopatológico de los gliomas craneales con técnicas de resonancia magnéti...

Background: Anterior cervical disc arthroplasty (ACDA) may rarely result in esophageal perforation. Case Description: A 56-year-old male underwent a C5–c6 ACDA for a cervical disc herniation. Three months postoperatively, trauma led to anterior dislocation of the interbody prosthesis, resulting in the acute onset of dysphagia accompanied by wound drainage. The delayed diagnosis of esophageal perforation was established when the cervical computed tomography documented anterior migration of the screws/plates and an air/fluid level in the surgical field. Despite a multidisciplinary approach, including anterior surgical revision followed by posterior stabilization, the patient became septic and expired. Conclusion: The incidence of esophageal perforation following ACDA ranges from 0.02% to 1.52%, with hardware failure being the leading cause. Prompt recognition and multidisciplinary management are essential for optimizing patient outcomes. Here, trauma-induced prosthesis dislocation warranting circumferential surgery failed to control sepsis, and the patient died.

Multisutural synostosis, characterized by the fusion of multiple cranial sutures without a clear underlying syndrome, represents a rare subtype of craniosynostosis. Particularly uncommon is the simultaneous fusion of the sagittal, metopic, and bilateral coronal sutures. This report details the case of a 50-month-old boy, who had an abnormal head shape due to the simultaneous fusion of four sutures. The closure of the sagittal, metopic, and bilateral coronal sutures has led to a distinct head shape marked by flattening of the forehead and anterior skull, contrasting with the typical Mercedes-Benz pattern observed in craniosynostosis cases. Surgical intervention involved osteotomy with symmetrical barrel staves in the parietal and frontal regions, resulting in improved forehead contour.

Osteoporotic vertebral compression fractures (OVCFs) significantly affect the quality of life of elderly patients by causing severe pain and functional loss. Percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP) are minimally invasive surgical techniques for the treatment of OVCFs. It can be performed unilaterally or bilaterally for prevention of kyphosis without morbidity. This study aims to compare the radiological and clinical outcomes of unilateral versus bilateral approaches in PKP/PVP procedures.This retrospective observational study included 230 unilateral (n = 110) and bilateral (n = 120) patients from three spinal centers who underwent PCP or PVP for OVCF treatment between 2018 and 2024. During the operation, operative time, cement volume, and frequency of fluoroscopy were recorded. The duration of hospital stay was recorded. Visual Analog Scale (VAS) scores and Oswestry Disability Index (ODI) scores were used for clinical evaluation at preoperative, postoperative day 1, and final follow-up. Vertebral height and kyphotic angle were used for radiological evaluation.The unilateral approach had significantly shorter operative times (43.4 ± 9.01 minutes, p < 0.001) compared to the bilateral approach (59.9 ± 11.5 minutes), required less cement (4.44 ± 1.01 mL vs. 7.53 ± 0.911 mL, p < 0.001), and had fewer fluoroscopy (26.2 ± 6.58 vs. 55.6 ± 9.98, p < 0.001). There were no significant differences between the two groups in VAS scores (p = 0.663), ODI scores (p = 0.650), vertebral height restoration (p = 0.720), or kyphotic angle correction (p = 0.129). However, the bilateral group had a higher rate of cement leakage (35 vs. 12%, p = 0.035).These findings suggest that the unilateral approach offers procedural advantages without compromising clinical efficacy, making it a preferable option for elderly patients with OVCFs.

Objective: In this randomized and prospective research, we aimed to relieve surgical and muscle-related pain early after lumbar disc operations with caudal p...