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Transsphenoidal endoscopic surgery is the first-line treatment for growth hormone-secreting adenomas. To analyse the results of the transsphenoidal endoscopic approach for acromegaly and to determine the predictive factors of remission. A single-centre retrospective review was performed in patients who underwent endoscopic transsphenoidal surgery for acromegaly between January 2009 and January 2019. Demographic features, clinical presentation, histopathology records, complications and pre- and postoperative radiologic and endocrinological assessments were evaluated. The factors that influenced the remission rates were investigated. A total of 73 patients underwent surgery via the transsphenoidal endoscopic approach. Cavernous sinus invasion was detected in 32 patients (43.8%); and macroadenoma, in 57 (78%). The pathology specimens of the 27 patients (36.9%) showed dual-staining adenomas with prolactin. A total of 51 patients (69.8%) attained biochemical remission 1 year after surgery. A second operation was performed in 10 patients (13.6%) with residual tumours without biochemical remission in the first year. Six (60%) of the patients attained remission at the last follow-up. Transient diabetes insipidus was observed in 18 patients (24.6%); and rhinorrhoea, which was resolved with conservative treatment, in 4 (5.4%). None of the patients developed panhypopituitarism. The presence of cavernous sinus invasion and preoperative IGF-1, immediate postoperative GH and third-month IGF-1 levels were predictive of remission. Transsphenoidal endoscopic surgery is a safe and effective treatment for acromegaly. Reoperation should be considered in patients with residual tumours without remission. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Istanbul Faculty of Medicine / İstanbul Tıp Fakültesi Dergisi is the property of Istanbul Tip Fakultesi Dergisi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Pediatric epilepsy surgery is an effective treatment modality for patients with drug-resistant epilepsy (DRE). Early pediatric surgery yields favorable results for DRE in terms of seizure control and neurophysiological outcome. In this study, pediatric patients were categorized based on their age (above 3 years old and below 3 years old) to demonstrate the effectiveness and safety of surgical procedures. Methods: In this retrospective, single-center study, 60 pediatric patients who underwent epilepsy surgery at Istanbul Faculty of Medicine between 2002 and 2018 were evaluated. Overall morbidity and mortality rates, as well as seizure outcomes of the patients, were assessed and compared based on two age groups: those aged 3 years old or younger and those older than 3 years old. The effectiveness of invasive monitoring was also evaluated in relation to pathological results. The postoperative seizure outcome rates were evaluated using Engel's classification, with an average follow-up period of 8.7 years. Results: Out of the total number of patients, 47 (78.4%) underwent resective surgery, while 13 (21.6%) had palliative surgery. Ten patients (16.6%) had invasive monitoring. Among all patients, 34 were classified as Engel I and II (56.6%), while 26 were classified as Engel III and IV (43.4%) postoperatively. 47% of patients who were under 3 years old, 60.4% of patients who were over 3 years old, and 50% of patients who underwent invasive monitoring had a favorable seizure outcome (Engel I–II). Postoperative morbidity and mortality rates were 35% (n = 21) and 1.6% (n = 1), respectively. Conclusion: Pediatric epilepsy surgery is an important treatment modality for preserving cognitive abilities and providing effective treatment for pediatric DRE. In our study, we claim that both invasive monitoring and epilepsy surgery lead to favorable seizure outcomes for all age groups. Further clinical studies should be conducted to provide more reliable data on the safety and effectiveness of the surgery, particularly in patients under the age of three. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the surgical outcomes of 24 patients with lumbar spinal stenosis (LSS) treated by full-endoscopic interlaminar bilateral decompression using a unilateral approach. Materials and Methods: Twenty-four patients (seven males and 17 females) treated for LSS by the senior author and followed up for 18 months were included in the study. The pre-operative and postoperative clinical statuses were assessed using a neurological examination, a visual analog scale (VAS) score, and the Oswestry disability index (ODI). Preoperative lumbar magnetic resonance imaging, computed tomography (CT), and postoperative lumbar CT were performed. Results: Eight patients had isolated lateral recess stenosis, six had central lumbar stenosis, and 10 had both. A total of 31 spinal levels were treated using full endoscopic percutaneous interlaminar decompression. In patients undergoing a single-level procedure, the pre-operative mean VAS score was 9 and the postoperative mean VAS score was 2.5. The mean ODI was 43.5 before surgery and decreased to 11 after surgery. In patients with multi-level intervention, the mean VAS score was 8.5 and the mean ODI was 40 before surgery. Postoperatively, both decreased to 3.5 and 14.5, respectively. All pre- and postoperative values were significantly different. Conclusion: Full-endoscopic interlaminar bilateral decompression using a unilateral approach provided adequate decompression in selected patients. It also prevents unnecessary surgical trauma and tissue damage and enables better preservation of spine stability, even in patients operated on at multiple spinal levels. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Superficial siderosis (SS) is caused by subpial hemosiderin deposition due to chronic low-grade bleeding into the subarachnoid space. Dural tears are the most common etiology. Slowly progressive gait ataxia and hearing impairment are common clinical manifestations. Brain magnetic resonance imaging (MRI) shows linear superficial hypointensity on the T2 weighted images and gradient echo. The therapeutic approach is surgical repair of the bleeding source. The patient presented with progressive hearing loss and ataxia. Neurological examination revealed bilateral hearing loss, nystagmus, dysarthria, brisk deep tendon reflexes, and severe ataxia. Brain MRI showed linear superficial siderosis in the cerebrum, cerebellum, and brain stem. Spinal MRI showed ventral epidural cerebrospinal fluid (CSF) collection and disc-osteophyte complex. Six months after the surgical repair of the dural defect, the patient's neurological examination demonstrated improvement in ataxia and dysarthria. The patient was able to walk without any assistance. Surgical repair of the underlying bleeding source may be beneficial in preventing the progression and improving the symptoms of superficial siderosis SS. This case suggests that SS symptoms are potentially reversible by surgical treatment of the underlying spinal CSF leak after a long disease course., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Talibov et al.)

Background: Subdural empyemas (SDEs) are rare intracranial infections mostly secondary to sinusitis. Incidence of SDEs is 5-25%. Interhemispheric SDEs are even rarer, which makes their diagnosis and treatment difficult. Aggressive surgical interventions and wide-spectrum antibiotics are needed for treatment. In this retrospective clinical study, we intended to evaluate the results of surgical management supported by antibiotics in patients with interhemispheric SDE., Methods: Clinical and radiological features, medical and surgical management and outcomes of 12 patients treated for interhemi-spheric SDE have been evaluated., Results: 12 patients were treated for interhemispheric SDE between 2005 and 2019. Ten (84%) were male, two (16%) were female. Mean age was 19 (7-38). Most common complaint was headache (100%). Five patients were diagnosed with frontal sinusitis prior SDE. Initially, three patients (27%) underwent burr hole aspiration and ten patients (83%) underwent craniotomy. In one patient both were done in the same session. Six patients were reoperated (50%). Weekly magnetic resonance imaging and blood tests were used for follow-up. All patients received antibiotics for at least 6 weeks. There was no mortality. Mean follow-up period was 10 months., Conclusion: Interhemispheric SDEs are rare, challenging intracranial infections that have been related to high morbidity and mor-tality rates in the past. Both antibiotics and surgical interventions play role in treatment. Careful choice of surgical approach and repeated surgeries if necessary, accompanied by appropriate antibiotic regimen, leads to good prognosis reducing morbidity and mortality.

Aim: To describe, and to evaluate the clinical and radiological characteristics of pediatric cavernous malformations (CMs) and the surgical approaches and their outcomes in a single center., Material and Methods: We retrospectively reviewed pediatric patients with CMs that were treated in our center between 2010 and 2020. Radiological, clinical, and demographic features, as well as treatment details were evaluated., Results: Of 23 patients, 12 were male, and 11 were female. Two patients with multiple CMs had a family history. The most common symptoms were headaches (9/23, 39.1%) and seizures (9/23, 39.1%). Twenty patients had single lesions and three patients had multiple lesions. According to Zabramski classification, eight (34.7%) patients had type 1, 11 (47.8%) had type 2 and four (17.3%) had type 3 lesions. Thirteen patients had recurrent preoperative hemorrhages and nine had increased lesion size. Seven patients (30.4%) had coexisting deep venous anomalies in the CM vicinity. Twenty-one patients underwent microsurgical resection (5/23 simple lesionectomy, 16/23 lesionectomy + resection of the surrounding hemosiderin ring). All lesions were completely resected. No surgical mortalities or major complications occurred., Conclusion: Since pediatric CMs are more aggressive than adult CMs, they should not be underestimated. Microsurgical total resection should be the first treatment choice where possible. We concluded that early surgical treatment and resection of perilesional hemosiderin-stained tissue, when feasible, yield the most favorable results at long-term follow-up including seizure outcomes.

Background: Supratentorial midline epidural hematoma is rare but challenging in diagnosis and management. Indication for surgery can arise even following hospital admission. Being familiar to the presentation and watching out for direct and indirect signs on axial computed tomography (CT) such as suture diastasis or fracture traversing midline are essential to plan multi-planar CT enabling exact diagnosis including form and mass effect of hematoma., Methods: Nine patients with midline epidural hematoma including two pediatric patients underwent surgery between 2013 and 2018. Pre-operative and post-operative patient status, radiological features, and surgical technique were analyzed., Results: Four patients had deteriorating consciousness levels and two patients had paraparesis. All had fractures traversing midline and epidural hematomas with significant mass effect. They were operated through separated craniotomies around the midline and midline bone strip was used for dural tenting and as support for natural closure of bone flaps. No post-operative complications were developed. All patients were discharged with Glasgow Outcome Score of 5., Conclusion: Because of the rarity of the lesion and small number of patients, definitive conclusions may be misleading but we think that, in experienced hands, midline epidural hematomas can safely be operated on and, preservation of midline bone strip pro-vides easier bleeding control.

Aim: To discuss seizure outcomes of patients with invasive electroencephalography (EEG) monitorization (IEM) following their epilepsy surgery at our centre., Material and Methods: Forty-seven patients suffering from refractory epilepsy and who were evaluated by invasive EEG were included in this retrospective study at Istanbul Faculty of Medicine from 2003 to 2017. We examined the Video EEG and invasive EEG monitorization, cranial MRI, SPECT, PET and neuropsychological tests of all patients. Postoperative seizure outcome results were evaluated according to Engel classification. The factors affecting seizure outcomes were discussed., Results: Twenty-six of the patients were female (55.3%), 21 were male (44.7). The average age was 32.0 (± 12.4). Forty-three patients had surgery and the average age of these patients was 26,6 (±11.15). 38.3% of the patients had hippocampal sclerosis (HS), 23.4% had focal cortical dysplasia (FCD), 8.5% had a tumor, 14.9% had sequela lesion and 14.9% had unknown etiology. Postoperative seizure status according to the Engel classification showed that 81.6% of the patients were class I, 10.5% were class II, 2.6% were class III and 5.3% were class IV., Conclusion: A significant relation was statistically determined between structural MRI lesion and favorable seizure outcome (p < 0.05). The most frequent etiology was HS in our patients. Of the patients with Engel I, the averages of their ages, ages at onset of epilepsy and ages at surgery were lower than other groups, but the difference was not statistically significant (p > 0.05). We argue that IEM is an essential examination for favorable outcomes for determining the epileptogenic zone and/or the proximity of the functional structures.

Aim: To present an early warning system (EWS) that employs a supervised machine learning algorithm for the rapid detection of extra-axial hematomas (EAHs) in an emergency trauma setting., Material and Methods: A total of 150 sets of cranial computed tomography (CT) scans were used in this study with a total of 11,025 images. Of the CTs, 75 were labeled as EAH, the remaining 75 were normal. A random forest algorithm was utilized for the detection of EAHs. The CTs were randomized into two groups: 100 samples for training of the algorithm (split evenly between EAH and normal cases), and 50 samples for testing. In the training phase, the algorithm scanned every CT slice separately for image features such as entropy, moment, and variance. If the algorithm determined an EAH on two or more images in a CT set, then the workflow produced an alert in the form of an email., Results: Data from 50 patients (25 EAH and 25 controls) were used for testing the EWS. For all CTs with an EAH, an alert was produced, with a 0% false-negative rate. For 16% of the cases, the practitioner received an email from the EWS that the patient might have an EAH despite having a normal CT scan. Positive and negative predictive values were 86% and 100%, respectively., Conclusion: An EWS based on a machine learning algorithm is an efficient and inexpensive way of facilitating the work of emergency practitioners such as emergency physicians, neuroradiologists, and neurosurgeons.