Abdurrahman Murat Yıldırım

Background/Objectives: To evaluate the clinical and MRI characteristics of benign solitary schwannomas of the extremities, compare pre- and postoperative neurological symptoms, and identify preoperative and intraoperative risk factors for postoperative complications. Methods: A retrospective review was conducted on 47 patients with histopathologically confirmed benign solitary schwannomas of the extremities who underwent surgical excision. Demographic data, MRI characteristics (tumor volume, perilesional edema, and degenerative changes such as cystic components or intratumoral hemorrhage), fascicular relationship, and use of tru-cut biopsy were recorded. Pre- and postoperative neurological symptoms were compared. Univariate logistic regression analysis was performed to identify factors associated with postoperative complications. Results: The mean age was 38.6 ± 15 years, and the mean follow-up period was 109.8 ± 65.1 months. Lesions were predominantly located in the upper extremity (65.9%), with a mean volume of 9.6 ± 4.8 cm³; perilesional edema and/or degenerative changes were present in 53.1% of cases. Postoperative complications occurred in 19.1% of patients, with intrafascicular involvement being a significant predictor (OR = 5.4, p = 0.037) and a positive preoperative Tinel’s sign showing a trend toward significance (OR = 4.2, p = 0.084). Tumor volume, perilesional edema, degenerative changes, tru-cut biopsy, and anatomical location were not significantly associated with complications. At final follow-up, pain remission was 82.1%, and paresthesia improvement was 63.6%. Conclusions: Intrafascicular involvement was associated with postoperative complications in univariate analysis, whereas preoperative MRI characteristics, biopsy, and Tinel’s sign showed no predictive value for postoperative risk.

Our study aims to investigate the factors associated with survival in patients with skeletal metastases of renal cell carcinoma and to outline the principles of managing patients with skeletal metastases using a multidisciplinary approach. We retrospectively reviewed 42 patients with clear cell metastatic renal cell carcinoma (mRCC) and bone metastases treated between 2005 and 2022. Demographics, tumor characteristics, metastasis patterns, surgical interventions, and systemic treatments were recorded. Survival outcomes were analyzed using the Kaplan-Meier method and the Cox proportional hazards model. Factors such as MSKCC and IMDC risk scores, the number and location of metastases, and treatment modalities were evaluated for their prognostic impact. Forty-two patients with a mean age of 58.4 years and a mean follow-up period of 28.4 months were included in the study. The 1-, 2-, and 5-year overall survival (OS) rates were 73.7%, 44.2%, and 13.7%, respectively. Solitary metastases (5-year OS 80%) and complete metastasectomy (5-year OS 20.1%) were associated with significantly improved survival. Diffuse metastases (HR 22.8; p = 0.006) and oligometastases (HR 7.7; p = 0.044) were associated with higher mortality compared to solitary lesions. Neither MSKCC nor IMDC scores were independently predictive of OS in multivariate analysis. Systemic therapies, including tyrosine kinase inhibitors (TKIs), mTOR inhibitors, antiresorptive agents, and radiotherapy, did not significantly impact survival outcomes. This study emphasizes that metastatic burden and achieving complete metastasectomy are the most critical factors for prolonged survival in metastatic renal cell carcinoma (mRCC) with bone involvement. Systemic therapies alone provide limited benefit, highlighting the need for individualized, multidisciplinary treatment strategies. Prospective studies are warranted to refine prognostic models and optimize care for this challenging patient group.

Objectives: Treatment of acromioclavicular joint dislocations vary. In this study, we aim to examine the functional results of patients who underwent hook plate fixation due to dislocation of acromioclavicular joint. Methods: We retrospectively observed 21 patients who had been treated with hook plate due to dislocation of acromioclavicular joint. At follow up, Constant-Murley scoring system was performed for shoulder function evaluation, while radiological results were performed by X-ray. Results: Seventeen of these patients were male and four were female. Eleven of these patients had Rockwood type 5 joint dislocation and ten had Rockwood type 3 joint dislocation. The mean age was 36.7 ± 13.37 years (range: 19-61 years). The mean follow-up period was 27.3 ± 19.3 months (range: 10-59). Constant-Murley shoulder scoring was excellent in 18 patients (93.6) and good (82.5) in 3 patients. While one patient had wound site infection and one patient had plate broken, no one had any neurological damage. Except for the failed implants, plate removal was not performed because the patients did not have plate-related complaints. At follow-up, it was observed that the acromioclavicular joint was in the reduced position on direct radiographs. Conclusions: We observed good clinical and functional results for the treatment of acromioclavicular joint dislocation with hook plate treatment. The hook plate method is a safe and effective method in the acute treatment of type 3-5 injuries according to the Rockwood classification.