Ayhan Tekiner

Aim: Prognostic counseling in adult diffuse glioma increasingly combines histologic grading with routinely available molecular testing. We assessed the incremental prognostic contribution of isocitrate dehydrogenase (IDH) status and O⁶-methylguanine-DNA methyltransferase (MGMT) promoter methylation beyond clinical variables and World Health Organization (WHO) grade in routine neuro-oncology practice.Material and Methods: We conducted a retrospective single-center cohort study of 82 adults who underwent surgery between 2017 and 2022. Three prespecified nested Cox models compared clinical and surgical variables alone, the same variables plus grade, and the full model plus molecular markers. Discrimination, calibration, reclassification, bootstrap optimism correction, and a prespecified subgroup analysis restricted to IDH-wildtype tumors were evaluated. Results: Apparent concordance improved from 0.738 to 0.878 to 0.885, with optimism-corrected values of 0.701, 0.829, and 0.834. WHO grade provided the main improvement in discrimination. Adding IDH and MGMT beyond grade yielded only a small and statistically uncertain increase. IDH-wildtype status remained the dominant adverse molecular feature, whereas no independent prognostic association of MGMT methylation was detected in either the mixed cohort or the IDH-wildtype subgroup.Conclusion: In this real-world cohort, grade and IDH status formed the principal prognostic framework, whereas the additional contribution of MGMT methylation to baseline risk discrimination remained uncertain. These findings are most relevant to resource-variable settings in which comprehensive molecular profiling is not uniformly available.

Objective: Methylprednisolone remains one of the most extensively studied pharmacological agents in the treatment of acute spinal cord injury; however, concerns regarding its adverse effects have prompted the investigation of alternative therapeutic strategies. This study aimed to evaluate the neurobehavioral and electrophysiological effects of Modafinil administered alone and in combination with Methylprednisolone in an experimental rat model of spinal cord injury.Methods: Twenty-five male Wistar Albino rats were randomly divided into five groups. Following laminectomy and standardized spinal cord trauma, Modafinil and/or Methylprednisolone were administered according to group allocation. Neurobehavioral recovery was assessed using the Inclined Plane Test, and electrophysiological evaluation was performed using motor evoked potential recordings.Results: A statistically significant difference in inclined plane angles was observed between the groups on postoperative day 1 (p < 0.01). Groups 4 and 5 demonstrated significantly higher functional scores compared to Group 2, whereas no significant difference was observed between Groups 2 and 3. In within-group analysis, functional improvement between day 1 and day 10 was significant in Groups 4 and 5 but not in Groups 1 and 2. Early post-traumatic amplitudes decreased significantly in all trauma groups. Late amplitude measurements demonstrated significant recovery within treatment groups, with greater improvement observed in the combined treatment group.Conclusion: Modafinil demonstrated beneficial neurobehavioral and electrophysiological effects in this experimental spinal cord injury model. The combined administration of Modafinil and Methylprednisolone resulted in greater functional and electrophysiological recovery, suggesting a potential synergistic effect. Further experimental and clinical studies are required to clarify its therapeutic role.

Objective: Intracranial aneurysms are pathological dilations of the intracranial arterial wall. The rupture of an aneurysm and the subsequent hemorrhage into the subarachnoid, intraventricular, or subdural spaces constitute a significant clinical condition associated with high morbidity and mortality. Aneurysmal subarachnoid hemorrhage (SAH) can lead to various severe complications, one of the most critical being ischemia due to cerebral vasospasm. In this study, we aim to analyze the relationship between the amount of hemorrhage and vasospasm. Method: This study was conducted on patients admitted to the Neurosurgery Clinic of the Ministry of Health Ankara Training and Research Hospital with a diagnosis of spontaneous subarachnoid hemorrhage (SAH). The diagnosis of SAH was established based on computed tomography (CT) imaging and lumbar puncture (LP) findings. To diagnose aneurysms, all patients underwent four-vessel cerebral digital subtraction angiography (DSA). The CT images obtained at the time of admission were evaluated using the Fisher grading system. Additionally, angiographic vasospasm was assessed. For the statistical evaluation of the obtained results, the Z-test and chi-square (X²) test were used to analyze proportions. Results: The mean age of the patients was calculated as 49 years. The age distribution of the cases was as follows: 36% were in the 40-49 age group, 27% in the 50-59 age group, and 15% in the 60-69 age group. In terms of gender distribution, female predominance was observed, with 64% of the 100 cases being female and 36% male. According to the Fisher grading system, the highest incidence of subarachnoid hemorrhage on brain CT was observed in grade 3. The percentage of patients classified as Fisher grade 3 was 36%, followed by 33% in grade 4, 23% in grade 2, and 8% in grade 1. Angiographic vasospasm was defined as a contrast-narrowing phenomenon in the main cerebral arteries, which could be either focal or, in some cases, diffuse. Clinical vasospasm was detected in 23% of cases, whereas angiographic vasospasm was identified in 59% of cases. The highest incidence of angiographic vasospasm was observed in Fisher grade 3, at a rate of 42.4%. This was followed by 32.2% in grade 4, 18.6% in grade 2, and 6.8% in grade 1. The high incidence in Fisher grade 3 was found to be statistically significant (p

Objective: We aimed to retrospectively evaluate and examine pediatric head trauma cases according to PECARN in the light of their neurological and clinical conditions. We wanted to contribute to the detection of TBI with minimum CT imaging rates in order to avoid radiation-related carcinogenesis. Method: 108 pediatric patients who were admitted to the emergency department due to minor head trauma and were admitted to the neurosurgery clinic were evaluated retrospectively. Result: During follow-up, 9 patients required intensive care and 5 patients underwent neurosurgical surgery. The most common trauma etiology was falling from one's own level with 53.7%. The most common tomography pathology was non-displaced fracture. According to the evaluations made in accordance with the PECARN algorithm, CT was recommended in 18 cases (16.7%); CT was not recommended for 32 cases. Conclusion: The clinician's goal is to quickly and accurately diagnose clinically significant TBI while avoiding unnecessary CT imaging to protect against the adverse effects of radiation. We recommend using the PECARN algorithm for this purpose.

The aim of this study was to investigate the effect of alpha lipoic acid on cerebrospinal fluid (CSF) osmolarity and brain tissue water ratio in a rabbit model of traumatic brain injury. Using a previously established model of traumatic brain injury using liquid nitrogen, 36 New Zealand rabbits were randomized into six groups (three treatment groups, a no trauma/no treatment group, a trauma/no treatment group, and a no trauma/treatment group). The treatment groups were administered intravenous alpha lipoic acid at different times of the experiment. Cerebrospinal fluid was obtained 96 hours after injury/treatment via cisterna magna puncture; glucose, blood urea nitrogen, and sodium levels were measured and osmolarity was calculated. Brain tissue water ratio was determined using wet and dry brain weights. The therapeutic effect of alpha lipoic acid was evaluated by comparing cerebrospinal fluid osmolarity and brain tissue water ratio between study groups. Based on cerebrospinal fluid osmolarity values, alpha lipoic acid treatment effectiveness was greatest in the group that received 3 doses after trauma. Alpha lipoic acid is efficacious in the treatment of brain edema after traumatic brain injury.