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Study design:Case report.Objectives:To report a penetrating gunshot injury at L1 with migration within the spinal canal to S2.Setting:Istanbul, Turkey.Methods:A 44-year-old man was admitted with an entrance gunshot wound on the left upper quadrant. An emergency exploratory laparotomy with left nephrectomy and transverse colon repair were performed. He had complete spinal cord injury below the level of L1. Lumbar magnetic resonance imaging (MRI) revealed hemorrhagic areas in conus medullaris and L1 corpus. The bullet was lodged at the S2 level. S1–S2 laminectomies were performed for the removal of the bullet. The antibiotic therapy was given for 17 days.Results:No meningitis or wound infection was observed after the operation. At discharge his neurological status was improved.Conclusions:The present case presented the movement of an intraspinal bullet after a spinal gunshot injury. No signs of infection were detected postoperatively. Lumbar MRI was used safely without any change in neurological status or patient discomfort.Spinal Cord (2006) 44, 326–329. doi:10.1038/sj.sc.3101808; published online 20 September 2005 [ABSTRACT FROM AUTHOR]

Background: Differential diagnosis of hypothalamic-optic chiasmatic gliomas (HOCGs) and craniopharyngiomas on magnetic resonance imaging (MRI) can be quite challenging., Purpose: To compare the MRI features of HOCGs and cranipharyngiomas., Material and Methods: Patients diagnosed with HOCG or craniopharyngioma in histopathological evaluation between 2012 and 2022 and who underwent preoperative contrast-enhanced brain MRI were included. Various MRI features were retrospectively evaluated for each lesion: T2-weighted imaging and fluid attenuation inversion recovery hyperintensity, calcification, cystic change, T1-weighted (T1W) imaging hyperintensity of the cystic component, hemorrhage, involvement of sellar, suprasellar or other adjacent structures, lobulated appearance, presence of hydrocephalus, and contrast enhancement pattern. Apparent diffusion coefficient (ADC) values were also evaluated and compared., Results: Among 38 patients included, 13 (34%) had HOCG and 25 (66%) had craniopharyngioma. Craniopharyngiomas had a significantly higher rate of cystic changes, calcification, and T1W imaging hyperintensity of the cystic component than HOCGs ( P  <0.05). Of HOCGs, 92% had chiasm involvement, 23% had optic nerve involvement, and 31% had brain stem involvement. On the other hand, chiasm involvement was observed in 8% of craniopharyngiomas, but none had optic nerve and/or brain stem involvement ( P  <0.05). While 62% (8/13) of HOCGs had diffuse homogeneous enhancement, 80% (20/25) of craniopharyngiomas had a diffuse heterogeneous enhancement pattern. Mean ADC values were significantly higher in craniopharyngiomas compared to HOCGs (2.1 vs. 1.6 ×10 -3 mm 2 /s, P  <0.05)., Conclusion: Although some neuroimaging findings may overlap, features such as presence of cyst and calcification, brain stem and optic pathway involvement, different enhancement patterns, and ADC values may be helpful in the differential diagnosis of HOCGs and craniopharyngiomas., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: Pseudotumor cerebri syndrome (PTC) is a chronic disorder, which is initially treated by conservative measures, yet surgery is inevitable in case of progressive worsening of vision or headache despite medical treatment. The surgical management is controversial including CSF diversion procedures and optic decompression. The purpose of this study was to evaluate the efficacy of different surgeries in PTC and to present surgical outcomes in a single center., Methods: This retrospective study included the patients with PTC who were operated by endoscopic optic nerve decompression (EOND), ventriculoperitoneal (VP) and lumboperitoneal (LP) shunting. Surgical outcomes, i.e. visual acuity, visual field, papilledema and headache were compared according to type of surgery. Surgical complications were noted., Results: Seventeen of 36 patients were treated with shunting, 14 with EOND and 5 patients with both EOND and shunting. No statistical significance was observed between CSF diversion procedures and EOND concerning clinical outcomes. The improvement rate of papilledema was higher with VPS (p = 0574) while more patients benefitted from LPS regarding visual field and acuity (p = 0471 and p = 0718, respectively). The best treatment response for headache was in shunt implemented patients (VPS and LPS) with a rate of 88.2% followed by EOND (78.6%) and both surgeries (60%)(p = 0.294). Gender and BMI were significant predictors of improved papilledema (p = 0.034)., Conclusions: Our study demonstrated comparable results between shunting and EOND, regarding the efficacy on surgical outcomes. EOND is quite effective for headache besides its advantage on treatment-refractory visual loss. Shunting may offer sustained relief of symptoms when compared with EOND., Competing Interests: Declarations of Competing Interest The authors declare that they have no conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objective: The aim of this study is to present the expressions of Calreticulin (CALR) and Glucagon-like peptide-1 (GLP-1) in high-grade gliomas and to further show the relation between the levels of these molecules and Ki-67 index, presence of Isocitrate dehydrogenase (IDH)-1 mutation, and tumor grade., Patients and Methods: A total of 43 patients who underwent surgical resection due to high-grade gliomas (HGG) (grades III and IV) were included. The control group comprised 27 people who showed no gross pathology in the brain during the autopsy procedures. Adequately sized tumor samples were removed from each patient during surgery, and cerebral tissues were removed from the control subjects during the autopsy procedures. Each sample was stored at -80°C as rapidly as possible until the enzyme assay., Results: Patients with high-grade gliomas showed significantly higher levels of CALR and significantly lower levels of GLP-1 when compared to control subjects (P = 0.001). CALR levels were significantly higher, GLP-1 levels were significantly lower in grade IV gliomas than those in grade III gliomas (P = 0.001). Gliomas with negative IDH-1 mutations had significantly higher CALR expressions and gliomas with positive IDH-1 mutations showed significantly higher GLP-1 expressions (P = 0.01). A positive correlation between Ki-67 and CALR and a negative correlation between Ki-67 and GLP-1 expressions were observed in grade IV gliomas (P = 0.001)., Conclusions: Our results showed that higher CALR and lower GLP-1 expressions are found in HGGs compared to normal cerebral tissues., (Copyright © 2023 Copyright: © 2023 Journal of Cancer Research and Therapeutics.)

Aim: To observe changes in the serum levels of visinin-like protein-1 (VILIP-1), caveolin-1 (Cav-1) and neuron-specific enolase (NSE) after glioma resection., Material and Methods: Consecutive 14 glioma patients with different histologic grade and 14 age and gender-matched healthy subjects were included in this pilot study. From the patients serum samples were taken in preoperative and on day 2 and 10 of postoperative periods. Healthy subjects provided serum sample once. The serum changes of three proteins were evaluated by ELISA. The results were compared between preoperative and postoperative periods and between patients and controls., Results: Preoperative serum levels of VILIP-1 (p=0.008) and Cav-1 (p=0.012) were significantly higher in the patients. Mean serum levels of VILIP-1 (p=0.002) and Cav-1 (p=0.013) again were significantly higher than those of the controls. NSE did not show significant changes compared to controls in none of the periods. There was a steady decline regarding all three molecules from preoperative to postoperative day 10. However, statistical comparisons did not reveal any significant difference with respect the decline in any molecule. Significant positive correlation was detected between preoperative serum levels of VILIP-1 and Cav-1 (p=0.00001) in the patients and the controls (p=0.0000)., Conclusion: This pilot study suggested that Cav-1 and particularly VILIP-1 may be used as a valuable serum biomarker for follow-up and for early detection of recurrence in high-grade gliomas. Future studies including larger cohort of patients with homogeneous group of glioma is required.

Purpose: The aim of this study was to investigate the efficacy of diffusion tensor tractography (DTT) of spinal cord on surgical planning and postoperative neurological outcomes in patients with spinal intramedullary tumors., Methods: The study was conducted retrospectively from the radiological and clinical data of our hospital database. Patients with intramedullary spinal cord tumors who underwent diffusion tensor imaging for spinal cord lesions were selected between 2019 and 2022. Demographic characteristics and intraoperative neurophysiological monitoring data were evaluated. The McCormick scale was used to grade the pre- and postoperative neurological status of the patients. The tumoral lesions were categorized into 3 types according to the fiber course on DTT., Results: Eleven patients were found to have radiological findings that were compatible with intramedullary tumor; eight (72.7%) of them ultimately underwent surgery following being approved as surgical candidates in the spinal diffusion tensor imaging studies. Six cases had Type 1, one case had Type 2, and 4 cases had Type 3 tumors according to the fiber course. All Type 1 tumors were classified as resectable and all of them were gross totally resected. Type 2 lesion that was rated as resectable by DTI was subtotally resected. Type 3 lesions were followed without surgery except the one with tumoral progression and neurological deficit. The postoperative neurological outcomes were compatible with intraoperative neurophysiological monitoring results., Conclusion: Diffusion tensor imaging and tractography may be beneficial regarding the selection of patients suitable for surgery and in the subsequent surgical planning., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background and Objective: Idiopathic intracranial hypertension (IIH) is a syndrome characterized with increased intracranial pressure and normal cerebrospinal fluid (CSF) composition. Treatment is mainly conservative, whereas CSF diversion surgery is the most frequently used surgical intervention. Endoscopic endonasal optic nerve decompression (EOND) is a newer surgical treatment of this patient group. This study presents a single clinic's case series with comparative results of unilateral an bilateral EOND with or without optic nerve fenestration., Methods: Sixteen patients with IIH syndrome who underwent 18 EOND procedures by a single neurosurgeon were evaluated with MRI and digitally subtracted angiography preoperatively. Both preoperative and postoperative visual acuity and perimetry and fundoscopy examinations were routinely performed. All patients underwent sphenoidotomy using the endoscopic binostril approach; however, unilateral or bilateral optic nerve decompression and accompanying optic sheath fenestration was determined on a case-by-case basis, after which all patients were also evaluated for the outcome of headaches., Results: Most of the patients were female, and the mean age was 30.28 ± 9.78 years. CSF pressure was increased in all patients (406.43 ± 112.91 mm of H 2 O), and the follow-up period was 61.72 ± 21.67 months. In patients with unilateral EOND, visual fields improved in 83%, visual acuity in 70%, headache in 75%, and papilledema in 27% of cases. In patients with bilateral EOND, perimetry improved in 86%, visual acuity in 43%, headache in 50%, and papilledema in 57% of cases., Conclusion: EOND is an effective surgical option in the treatment of IIH. Bilateral decompression is preferable in patients with bilateral visual involvement, and optic nerve fenestration may prove to be helpful in patients with IIH whose primary complaint is headache., (Copyright © Congress of Neurological Surgeons 2023. All rights reserved.)

Anterior cervical discectomy and fusion (ACDF) is a safe and effective surgical treatment for cervical degenerative disk diseases. Almost every neurosurgeon is familiar with this approach. Anterior multilevel epidural hematoma (EDH) after a single ACDF is a very rare complication documented in the literature. There is no common consensus on the choice of optimal surgical treatment. Here, we report the case of a patient who showed multilevel EDH after ACDF at the C5-6 level to highlight that this complication should be kept in mind even after an uneventful surgery., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Cetintas et al.)

Purpose: The changes in serum amino acid profiles are evaluated in different types of cancers and screening tests were developed for estimating the risk of cancer by rapid analysis of plasma free amino acid (PFAA) levels. There is scarce evidence about the metabolomics analysis of PFAA in malignant gliomas. The aim of the present study was to identify the most promising diagnostic amino acid biomarkers that could be objectively measured for high-grade glioma and to compare their level with the tissue counterpart., Methods: In this prospective study, we collected serum samples from 22 patients with the pathological diagnosis of high-grade diffuse glioma according to WHO 2016 classification and 22 healthy subjects, and brain tissue from 22 controls. Plasma and tissue amino acid concentrations were analyzed applying liquid chromatography-tandem mass spectrometry (LC-MS/MS) method., Results: Serum alanine, alpha-aminobutyric acid (AABA), lysine (Lys) and cysteine concentrations were significantly higher in high-grade glioma patients despite low levels of alanine and Lys in the tumor tissue. Aspartic acid, histidine and taurine were significantly decreased in both serum and tumors of glioma patients. A positive correlation was detected between tumor volumes and serum levels of latter three amino acids., Conclusion: This study demonstrated potential amino acids which may have diagnostic value for high-grade glioma patients by utilizing LC-MS/MS method. Our results are preliminary to compare serum and tissue levels of amino acids in patients with malignant gliomas. The data presented here may provide feature ideas about the metabolic pathways in the pathogenesis of gliomas., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Aim: To compare tissue levels of the regulatory enzymes related to the Krebs cycle between low, and high-grade supratentorial gliomas., Material and Methods: Forty patients who underwent surgery for supratentorial gliomas (19 with low-grade and 21 with high-grade gliomas) were evaluated. The regulatory enzymes directly involved in the Krebs cycle, namely pyruvate dehydrogenase, citrate synthase, ?-ketoglutarate dehydrogenase, and isocitrate dehydrogenase, and two enzymes that indirectly regulate the Krebs cycle, namely glutamate dehydrogenase and glutaminase, were quantitatively studied in tumor tissues using ELISA. The results were compared between the two groups., Results: The levels of all enzymes were higher in the high-grade glioma group but only pyruvate dehydrogenase, citrate synthase, and isocitrate dehydrogenase levels showed statistical significance. Moreover, all enzymes showed higher tissue levels in grade- II compared to grade-I gliomas, but only two enzymes, glutamate dehydrogenase and glutaminase, reached significantly higher levels. In the high-grade glioma group, all enzymes again showed higher tissue levels in grade-IV gliomas than in grade-III gliomas, but none showed statistical significance., Conclusion: Regulatory enzymes of the Krebs cycle are increased in high-grade gliomas compared to low-grade gliomas. Glutaminolysis enzymes, namely glutamate dehydrogenase and glutaminase, which are required for resupplying the Krebs cycle, are also increased in order to meet the high energy demand in high-grade gliomas.

Aim: To evaluate the preoperative, operative, and postoperative outcomes of young and adult patients who underwent surgery for temporal lobe epilepsy related to hippocampal sclerosis (TLE-HS)., Material and Methods: This retrospective study assessed prospectively registered data collected from 2010 to 2020. Clinical, electrophysiological, pathological, and postoperative outcomes were evaluated and compared. Post-surgical seizure outcome was classified into continuous seizure freeness without aura and relapse., Results: In total, 16 young and 48 adult patients with TLE-HS were included in the analysis. The clinical, electrophysiological, pathological, and postoperative outcomes were similar between the young and adult groups. However, the seizure outcome did not significantly differ between the two groups (p=0.38). A significant proportion of patients in both groups were satisfied with the surgical outcomes., Conclusion: Surgery is extremely effective against TLE-HS in young patients, as in adults. Furthermore, the clinical, radiological, and pathological outcomes are similar between young and adult patients with TLE-HS.

Temporal lobe epilepsy (TLE) is one of the most common forms of focal epilepsy. Anterior temporal lobectomy (ATL) leading to high rate of seizure freedom is a safe and well-established procedure in TLEs. Cranial nerve deficits, especially for oculomotor, trochlear and facial nerve were reported as a complication after ATL. Nonetheless, trigeminal neuralgia due to ATL is a very rare complication documented in the literature. The surgeons performing ATL procedures must be aware of the risk of trigeminal nerve injury, avoid excessive electrocautery use in the medial part of middle fossa and provide clean surgery in there to prevent this rare complication., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Background: To assess the efficacy of postoperative antibiotics on postoperative infection in clean supratentorial craniotomies., Methods: This study is a prospective, randomized, single-blind, and placebo-controlled clinical trial that included consecutive patients who underwent clean supratentorial craniotomy between November 2017 and September 2020 and evaluated the effectiveness of postoperative antibiotic prophylaxis on postoperative infection., Results: A total of 80 patients were included and the whole group was divided into two groups. Group A included patients who received antibiotic prophylaxis and group B who did not receive antibiotic prophylaxis after surgery. Each group included the same number of patients (40 patients in each). Two patients showed postoperative infection, and both were in group B. No significant difference was found regarding postoperative infection between the two groups (p = 0.15). The rate of postoperative infection was found to be 2.5% in the whole group (2 cases out of 80) and it was 5% in group B (2 cases out of 40)., Discussion: Our results showed that antibiotic prophylaxis after a clean supratentorial craniotomy has no effect on the prevention of postoperative infection and we do not suggest using antibiotic prophylaxis after clean supratentorial neurosurgery.

Background: High-grade gliomas have limited time of survival despite aggressive treatment. Patients experience a decline in their physical and mental capacities, affecting their quality of life (QoL), and require proper therapeutic strategies., Objective: To assess the QoL of malignant glioma patients before and after the treatment in a longitudinal study of six months., Methods and Material: Forty-nine patients who were pathologically diagnosed with glioblastoma and anaplastic glioma according to WHO 2016 were included in this prospective study. The assessment of quality of life was done using the European Organization for Research and Treatment of Cancer (EORTC) quality of life (QoL) questionnaire core-30 prior to surgery, 1 and 5 months after the operation., Results: The decline in Karnofsky scores of the patients was statistically significant. Among the symptom scales, fatigue was more prominent after surgery while pain was noticeable during chemotherapy which was correlated with increased age. The mean overall QoL scores showed a clinically significant decline during the postoperative period. The functional scores demonstrated a significant decline in between all periods. Sex was significantly correlated with preoperative emotional and physical functioning. The patients with right-sided lesions had higher mean scores for social and cognitive functioning., Conclusions: Low KPS, older age, and female gender may affect cancer symptoms and physical and social activities in malignant glioma patients. Cognitive functions as well as social and occupational roles gradually decline during the first six months of treatments. Overall QoL of high-grade glioma patients deteriorates especially after radiotherapy and during the first months of chemotherapy., Competing Interests: None

Aim: To measure the serum levels of strong angiostatic and synaptogenetic molecules thrombospondin-1 (TSP-1) and thrombospondin-2 (TSP-2) in patients with temporal lobe epilepsy (TLE) before and after surgery., Material and Methods: In this prospective study, 20 patients operated for TLE and 20 healthy subjects were included. Serum levels of TSP-1 and TSP-2 were measured using enzyme-linked immunosorbent assay (ELISA)., Results: Our findings showed that both groups had higher serum levels of both molecules "before" surgery than 10 days ?after?, Surgery: However, a significant difference was noted between ?before? and "after" surgery regarding TSP-1 (p=0.00001). Although a marked decrease was found "after" surgery with respect to TSP-2, the difference did not reach statistical significance (p=0.22). In patients with TLE, serum levels of both molecules ?before? surgery were found to be significantly higher than in healthy controls (TSP-1, p=0.00001; TSP-2, p=0.007)., Conclusion: Serum levels of TSP-1 and TSP-2 are determined to be higher in patients with TLE than in healthy subjects, and the resection of epileptogenic tissues decreases the serum levels of these molecules. Future studies should involve a higher number of patients with serial serum levels of TSP-1 and TSP-2 at the long-term follow-up to correlate with seizure outcome.

Aim: To measure serum levels of thrombospondin-1 (TSP-1) and thrombospondin-2 (TSP-2) in patients with common brain tumors, namely high-grade glioma (HGG), low-grade glioma (LGG), and meningioma., Material and Methods: For this prospective study, a total of 56 patients were operated on for supratentorial gliomas and meningiomas, and 18 healthy subjects were evaluated. Serum levels of angiostatic molecules were measured with enzyme-linked immunosorbent assay. The results of patients were compared with those of healthy subjects., Results: High serum levels of TSP-1 were seen in HGG, followed by LGG, meningioma groups, and controls. The only significant difference was found between HGGs and controls (p=0.004). There was a trend to decrease from HGG to controls. High serum levels of TSP-2 were seen in controls, followed by meningioma, LGG, and HGG. None of the patient groups showed significant differences compared with controls. Among the patient groups, TSP-2 was significantly higher in the meningioma group than the HGG group (p=0.01). No correlation was found with any of the molecules and the clinical parameters, including the presence of peritumoral edema or seizure, the anterior-posterior diameter of the tumor, and, more importantly, the grade of glioma., Conclusion: Our results indicate that TSP-2 might be more important than TSP-1 in preventing angiogenesis and a major angiostatic factor in glioma cells.

This study aimed to investigate ultrastructural synaptic alterations in rat hippocampus after in utero exposure to irradiation (IR) and postnatal exposure to hyperthermia (HT). There were four groups in each of the time points (3 rd and 6 th months). IR group: Pregnant rats were exposed to radiation on the 17 th gestational day. HT group: Hyperthermia was applied to the rat pups on the 10th day after their birth. IR+HT group: Both IR and HT were applied at the same time periods. Control group: No IR or HT was applied. Rat pups were sacrificed after 3 and 6 months. Thin sections from the dentate gyrus (DG) and the CA3 of hippocampus were evaluated for synapse numbers by electron microscopy. Synapses were counted, and statistical analysis was performed. Abnormalities in myelin sheath, mossy terminals and neuropil were observed in the CA3 and DG of all groups. The synapses in the CA3 region were significantly increased in the IR-3 rd month, IR-6 th month, and IR+HT-3 rd month groups vs control group. Synapses were significantly increased in the DG of HT-3 rd month group. A trend for an increase in synapse numbers was seen in the CA3 and DG. Increased number of synapses in the rat hippocampus may be due to mossy fiber sprouting, possibly caused by in utero irradiation and/or postnatal hyperthermia.

The most common approaches in the treatment of epilepsy, the trans-sylvian selective amygdalohippocampectomy (SAH) and the anterior temporal lobe resection (ATLR) reach the medial temporal lobe through different surgical routes. Our aim was to delineate the white matter (WM) fiber tracts at risk in relation to trans-sylvian SAH and ATLR by defining each fascicle en route to medial temporal lobe during each approach. ATLR and trans-sylvian SAH were performedand related WM tracts en route to medial temporal region were presented in relation to the relevant approaches and surrounding neurovascular structures. The WM tracts most likely to be disrupted during trans-sylvian SAH along the roof of the temporal horn were the UF - and less commonly IFOF - at the layer of the external capsule, anterior commissure, anterior bend of optic radiations, and sublenticular internal capsule. Amygdaloid projections to the claustrum, putamen and globus pallidus, the tail of caudate and the peduncle of the lentiform nucleus were also in close proximity to the resection cavity. Fiber tracts most likely to be impaired during ATLR included the UF, ILF, IFOF, anterior commissure, optic radiations, and, less likely, the vertical ventral segment of the arcuate fascicle. Both ATLR and trans-sylvian SAH carry the risk of injury to WM pathways, which may result in unpredictable functional loss. A detailed 3-D knowledge of the related connectional anatomy will help subside neurocognitive, neuroophtalmologic, neurolinguistic complications of epilepsy surgery, providing an opportunity to tailor the surgery according to patient's unique connectional and functional anatomy., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Multinodular and vacuolating neuronal tumor (MVNT) recently described as a purely neuronal tumor. Although its nature as a genuine tumor is controversial, this new entity assumed benign lesion and mostly affecting adults. Herein, we introduce two cases of MVNT presumed low grade glial tumor (LGG) and focal cortical dyplasia (FCD) as a differential diagnosis., Case Description: Case 1 has admitted to our hospital with headache which frequency and severity has increased within two months. Radiological examination revealed hyperintensity on T2-WI and T2 FLAIR images. Microsurgical resection was performed and histopathological findings were compatible with MVNT instead of low grade glial tumor as we thought. Case 2, who presented at our hospital with one episode seizure. MRI showed T2 hyperintensity and T1 hypointensity without contrast enhancement. We suspected FCD, thus performed microsurgical gross total resection with frontal craniotomy. Pathological findings confirmed MVNT as a diagnosis. Both cases were discharged on the 3rd day after surgery without any complications and with no regrowth of tumor at the 9-months and 3-months follow-up respectively., Conclusions: Radiological hallmarks may be helpful to prevent from aggressive treatment in case of patient is asemptomatic. Nevertheless further studies are necessary for the adoption of 'wait and see' philosophy and give a verdict about benign nature of these tumors., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Despite their rare occurrence, intramedullary spinal cord tumors can cause considerable morbidity and mortality without treatment. Timing of surgery, extent of resection and selection of favorable treatment option are important considerations for a good surgical outcome. In this clinical study, we report our patient series and convey our treatment strategy. We retrospectively reviewed 91 patients with primary intramedullary spinal cord tumors who underwent microsurgical resection at our institution between 2008 and 2018. Data were collected consisting of age, sex, location and histology of tumor, extent of resection, presenting symptoms and neurological outcomes. Modified McCormick Scale was used to assess neurological status of patients. 47 female and 44 male patients were followed-up for a mean period of 35.7 months. The most frequent pathological diagnosis was ependymoma in 56 patients, followed by astrocytoma in 21 and hemangioblastoma in 5 patients. The rest of the tumors consisted of 3 cavernomas, 3 mature cystic teratomas, 2 PNET, one epidermoid tumor. Gross total resection was achieved in 67 patients, while subtotal resection and biopsy was performed in 15 and 9 respectively. The most commonly involved localization was cervical (n = 39), followed by thoracic region (n = 24). Despite immediate postoperative worsening of neurological status, a great number of patients improved at the last follow-up. Gross total resection remains the primary goal of treatment while adjuvant radiation and/or chemotherapy may be alternative options for high grade tumors. Preoperative neurological status was the most important and the strongest predictor of functional outcome., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: To share our experience related to clinic and radiologic outcomes of patients with Chiari I malformation., Patients and Methods: This retrospective study evaluated surgical outcome of 48 patients who underwent posterior fossa decompression and duraplasty with arachnoid-preservation technique February 2010 and February 2019. Clinic and radiologic outcomes at long-term follow-up were provided., Results: Surgery led to satisfactory outcomes in both clinic and radiologic measures. The majority of patients (66.7%) in the follow-up period informed us that their symptoms significantly improved. In 14 patients (29.2%), the symptoms were gone totally and no complaining was reported to us. Syringomyelia was encountered in 21 patients (43.7%) on pre-operative MRI. During long-term, significant improvement (syrinx segments were remarkably reduced in diameter) in syrinx size was noted in 16 of the 21 patients (76.1%). In 5 of the 21 patients (23.8), complete improvement, that is, syrinxes were totally collapsed, was seen. Surgery-related complications occurred in a total of 5 patients (10.4%)., Conclusion: In our experience, we found decompressive craniectomy wide enough with duraplasty without arachnoid opening is safe and successful in patients with CIM. Complication rate is low and arachnoid preserving technique should be performed by experienced neurosurgeons., (Copyright © 2019 Elsevier B.V. All rights reserved.)

This retrospective analysis of patients aims to show the blood levels of preoperative inflammatory markers in patients with glioblastoma and brain metastasis and to provide the diagnostic accuracy of the neutrophil-lymphocyte (NLR), lymphocyte-monocyte (LMR), and platelet-lymphocyte (PLR) ratios between the 2 groups of patients.The retrospective reviews of the neutrophil, lymphocyte, monocyte, and platelet counts were analyzed in 80 patients with newly diagnosed glioblastoma and 70 patients with brain metastasis. The NLR, LMR, and PLR were calculated in each group. The differences in all the parameters were compared between the 2 groups.Although the neutrophil, monocyte, and platelet counts were higher and the lymphocyte count was lower in patients with metastasis, the difference was not significant. A significantly higher PLR (P = .004) and a lower LMR (P = .01) were found in patients with brain metastasis. Although both PLR and LMR had diagnostic accuracy in differentiating glioblastoma from brain metastasis, LMR showed the highest diagnostic accuracy. NLR showed no diagnostic accuracy.Systemic inflammation is more severe in glioblastoma than in brain metastasis, and LMR is more sensitive and/or specific than PLR in differentiating glioblastoma from brain metastasis. Therefore, LMR (less likely PLR) can be used as an index for differentiating between glioblastoma and brain metastasis before surgery.

Background: Vascular malformations of the spinal cord are a rare and complex clinical entity and can lead to severe morbidity with progressive spinal cord symptoms if not treated properly. In early stages, the disease is characterized by slowly progressive, nonspecific symptoms, such as gait disturbance, paresthesia, diffuse sensory symptoms, and radicular pain; in the late stages, bowel and bladder incontinence, erectile dysfunction, and urinary retention may develop. In recent decades, understanding and treatment of spinal vascular malformations have improved with the evolution of diagnostic tools and treatment modalities; however, it is still difficult to manage these cases because of the complexity of the pathology. The aims of this study were to present the long-term outcomes of our patients and to discuss the optimal management strategies., Methods: We reviewed the records of 78 patients with spinal vascular malformations and performed a retrospective, single-center case series evaluating initial occlusion, recanalization, retreatment, and neurologic status of patients with dural arteriovenous fistulas, perimedullary arteriovenous fistulas, arteriovenous malformations, and extradural arteriovenous fistulas who had undergone embolization and/or surgery., Results: No mortality was observed. Complete obliteration was achieved in 76 patients (97.4%)., Conclusions: Both endovascular and surgical treatment of spinal vascular malformations resulted in significant long-term recovery from myelopathic symptoms and improvement in quality of life for most patients., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Temporal neocortex which appears normal on magnetic resonance imaging (MRI) may have pathological tissues in low-grade gliomas (LGG) of pure mesial temporal area. Resection of the cortex may be required together with mesial temporal glioma for satisfactory seizure and oncological outcome. The aim of this study was to explore the presence of any pathological tissue on the temporal cortex that appeared normal on preoperative MRI in patients with pure mesial temporal LGGs., Methods: This prospective study included 10 patients who underwent surgical resection of temporal lobe for LGG of mesial temporal area. The temporal neocortex with normal appearance on MRI and mesial temporal area were resected separately, and histopathological diagnosis was performed., Results: LGGs of the mesial temporal area were diagnosed with glioneuronal tumors in 7 (70%) and low-grade astrocytoma in 2 (20%) patients. Regarding the temporal cortex, gliosis and focal cortical dysplasia were found in 7 (70%) and 2 (20%) patients. In one patient temporal cortex did not contain any pathological tissue. All were seizure-free and no tumor recurrence was noted at the last follow-up., Conclusion: Mesial temporal LGGs are not alone and a high proportion of temporal neocortex appeared normal on preoperative MRI, may contain dual pathology. Thus, anterior temporal resection should be performed to have satisfactory seizure and oncological outcomes., Competing Interests: There are no conflicts of interest., (Copyright: © 2019 Surgical Neurology International.)

Purpose: Preoperative neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) are recognized as prognostic markers of grade of gliomas. The aim of this study was to determine whether preoperative levels of NLR, PLR, and LMR differ between low- and high-grade gliomas., Methods: Retrospective analysis of preoperative neutrophil, lymphocyte, monocyte, and platelet counts and NLR, PLR, and LMR were performed in 171 patients who underwent glioma surgery. The results were compared between low- and high-grade gliomas., Results: Neutrophil count was significantly increased while lymphocyte count significantly decreased in high-grade gliomas (HGGs). NLR and PLR were significantly higher in HGGs but LMR was significantly reduced in HGGs. NLR and PLR correlated with glioma grade and only NLR showed highest accuracy predicting higher grade., Conclusions: Levels of preoperative NLR value can help to evaluate disease progression and predict higher grade of glioma.

Objective: To see what happens on PET hypometabolism on the temporal lobe contralateral to the side of surgery in patients with bitemporal hypometabolism (BTH)., Patients and Methods: This retrospective study with prospectively defined data evaluated the pre- and post-surgical PET hypometabolism on the contralateral temporal lobe after resection of ipsilateral temporal lobe in 10 patients with BTH operated between January, 2010 and May, 2018. On PET we compared standard uptake values (SUV) and relative metabolic activities as compared to normal subjects by means of Z-scores of hypometabolism of unresected temporal lobes before and after surgery., Results: Surgery did not lead to satisfactory seizure outcome and only 3 patients were seizure free. All but one were still using anti-epileptic drug. No significant change was noted on PET hypometabolism related to the contralateral temporal lobe at the last follow-up. Regarding the mean SUV, comparisons showed that the difference with respect to the mesial structures was significant (p = 0.04). But lateral cortex showed insignificant difference (p = 0.21) before and after surgery. Regarding the mean Z-score, no significant differences were found between both the mesial temporal structures (p = 0.23) and lateral temporal cortex (p = 0.18)., Conclusion: Surgery does not lead to improvements on PET hypometabolism of the temporal lobe contralateral to the side of surgery and hypometabolism on the contralateral side may be due to structural damage rather than functional deficits secondary to propagation of repetitive seizures. Seizure outcome is not satisfactory and before surgery patients or their next of kin should be informed in detail., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Aim: To analyze preoperative inflammatory markers including neutrophil, lymphocyte and platelet counts and neutrophil to lymphocyte (NLR) and platelet to lymphocyte (PLR) ratios in a group of patients with different brain pathologies and healthy controls., Material and Methods: Above mentioned preoperative inflammatory markers were analyzed in a total of 140 patients included 39 with temporal lobe epilepsy, 37 with glioblastoma multiforme, 32 with grade-I meningioma and 32 with intracranial metastasis. Healthy controls included 30 subjects. The levels were compared between each patient group and between patients and controls., Results: Significant higher neutrophil, platelet counts, NLR and PLR were found in glioma, meningioma and metastasis patients compared to epilepsy (p < 0.05). On the other hand lymphocyte counts were significantly lower than epilepsy (p < 0.05). PLR > 120.78 was suggestive of metastasis rather than GBM., Conclusion: Preoperative inflammatory markers increase in different brain pathologies and metastasis show striking changes. PLR can have diagnostic value in differentiating metastasis from GBM.

Objective: To report long-term clinical and seizure outcomes of patients who were operated upon insular gliomas via trans-opercular approach., Patients and Methods: Since 2010, surgical resection of insular gliomas was performed via trans-opercular approach by our group. Clinical, surgical and follow-up results were analyzed retrospectively., Results: The majority were low-grade (81.8%) and among them oligodendroglioma was the most common (n = 8). Half of the patients underwent awake craniotomy with cortical electrical stimulation and total removal was achieved in 6 patients. Long-term follow-up showed the majority of patients (90.9 %) were completely seizure free. Only one patient showed slight paresis on one upper extremity at the long-term follow-up., Conclusions: Trans-opercular approach for insular gliomas is safe and maximal resection with minimal neurological deficits is possible. Use of ultrasonic aspirator and neuronavigation make surgery safer. Surgery-related complication is very rare. Future studies should contain larger number of patient and long-term follow-up in order to provide more accurate data., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Temporal lobe epilepsy (TLE) is the most common form of focal epilepsy. Focal cortical dysplasia is the most common dual pathology found in association with the hippocampal sclerosis. In this study, the effect of dual pathology on freedom from seizure was sought in patients with TLE., Methods: This study performed a retrospective analysis of patients with TLE who underwent surgery between 2010 and 2017. Histopathologic analysis was performed on patients with and without dual pathology in the temporal neocortex. Seizure outcomes were compared., Results: A total of 54 patients with TLE were included. The rate of overall favorable seizure outcome was found to be 96.3%. In 53.7%, dual pathology was present in the temporal cortices in addition to the hippocampal sclerosis. Patients without dual pathology showed significantly greater freedom from seizure (P = 0.02)., Conclusions: Patients without dual pathology had a significantly higher seizure-free rate after anterior temporal resection than patients with dual pathology. Resection of the temporal cortex in addition to mesial temporal structures seems to be reasonable for better seizure outcome., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Temporal lobe epilepsy is the most common form of focal epilepsy, and surgical treatment has been proven to be an effective and safe management. Despite its safety, it is important to know that some complications and/or even death can be seen after surgery. Neurosurgeons should be able to precisely inform epilepsy surgery candidates about the possible unwanted/unexpected conditions after surgery., Methods: Fifty-three patients who underwent anterior temporal lobe resection due to temporal lobe epilepsy by a single surgeon were investigated retrospectively regarding postoperative surgical and neurological complications., Results: Overall complication rate was found to be 19%, surgical complications comprised 13.2% whereas neurological complications were 5.8%. Three patients underwent a second surgery whereas the rest had medical treatment or recovered spontaneously. Fortunately persistent complication rate was found to be 0%, and there was no mortality., Conclusions: Anterior temporal lobe resection is a safe and very effective surgical modality for the treatment of temporal lobe epilepsy. However, unexpected complications may be possible in this modern era and a surgeon should trust in him/herself not in modern equipments., Competing Interests: There are no conflicts of interest.

Background: Paraplegia following thoracic spinal surgery or abdominal operations is usually attributed to spinal cord ischemia due to interruption of the segmental spinal vascular supply. Alternatively, the etiology of spinal cord ischemia following cervical surgery is less clear., Case Description: A 14-year-old male became acutely tetraplegic with a C4 sensory level and sphincteric dysfunction 12 h following surgery for tracheal stenosis due to prior intubation. Signs included loss of pain and temperature below the level of C4 with preservation of deep sensations (position and vibration) and mute plantar responses. The cervical magnetic resonance imaging revealed diffuse intramedullary cord swelling between C2-C7 and hyperintense signal changes in the anterior and posterior columns of the cord on T2-weighted images. Various etiologies for this finding included a cervical hyperextension or hyperflexion injury vs. anterior spinal artery syndrome., Conclusions: Postoperative treatment of spinal cord ischemia attributed to cervical and thoracoabdominal surgery is largely ineffective in reversing major neurological deficits. Therefore, it is critical to prevent ischemia during these procedures by the avoidance of coagulopathies, anemia, hypotension, and hyperflexion/hyperextension maneuvers., Competing Interests: There are no conflicts of interest.

Objective: We sought to simply demonstrate how levels of soluble human epoxide hydrolase-2 show changes in both temporal the cortex and hippocampal complex in patients with temporal lobe epilepsy., Methods: A total of 20 patients underwent anterior temporal lobe resection due to temporal lobe epilepsy. The control group comprised 15 people who died in traffic accidents or by falling from a height, and their autopsy findings were included. Adequately sized temporal cortex and hippocampal samples were removed from each patient during surgery, and the same anatomic structures were removed from the control subjects during the autopsy procedures. Each sample was stored at -80°C as rapidly as possible until the enzyme assay., Results: The temporal cortex in the epilepsy patients had a significantly higher enzyme level than did the temporal cortex of the control group (P = 0.03). Correlation analysis showed that as the enzyme level increases in the temporal cortex, it also increases in the hippocampal complex (r 2  = 0.06, P = 0.00001). More important, enzyme tissue levels showed positive correlations with seizure frequency in both the temporal cortex and hippocampal complex in patients (r 2  = 0.7, P = 0.00001 and r 2  = 0.4, P = 0.003, respectively). The duration of epilepsy was also positively correlated with the hippocampal enzyme level (r 2  = 0.06, P = 0.00001)., Conclusions: Soluble human epoxy hydrolase enzyme-2 is increased in both lateral and medial temporal tissues in temporal lobe epilepsy. Further studies should be conducted as inhibition of this enzyme has resulted in a significant decrease in or stopping of seizures and attenuated neuroinflammation in experimental epilepsy models in the current literature., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: Maintaining of precise balance between oxidation and anti-oxidation is important in both physiological and pathological states. Knowledge about this balance may give an idea about the process of the disease. The aim of this study was to investigate dynamic thiol-disulfide homeostasis in patients with low-grade gliomas., Patients and Methods: Serial serum samples were collected in 13 patients operated on low-grade gliomas before and after surgery. Control serum samples were obtained from venous cord blood from 13 healthy women during cesarean section. Total thiol, native thiol, and disulfide bond formation were measured and compared with the controls., Results: Total thiols, native thiols, and disulfide bond formation were significantly elevated in patients before the surgery compared to the controls (p<0.05). Even after the surgery, these three parameters were still high in patients, and the differences were significant (p<0.05). Although no significant difference was found between patients and controls regarding the ratios of disulfide/total thiol, disulfide/native thiol, and native thiol/total thiol (p>0.05), the balance seemed to shift to oxidative side., Conclusions: Thiol-disulfide homeostasis was disrupted in patients with low-grade gliomas, and oxidation may play a role in the process of this disease. Supplementation with antioxidants before and after surgery may be taken into consideration., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objectives: Cell adhesion molecules play a major role in various pathological states. The aim of this study was to evaluate the tissue levels of selectins (E-, L-, and P-Selectins), activated leukocyte cell adhesion molecule (ALCAM) and platelet endothelial cell adhesion molecule-1 (PECAM-1) in intracranial meningiomas and compare with the levels in control tissues., Patients and Methods: 20 consecutive patients who were operated on meningiomas (grade-I: 17 and grade-II: 3) and 15 cerebral tissues obtained during the autopsy procedures as a resource for the healthy controls were included in this study., Results: All three selectins', ALCAM and PECAM-1 levels were found to be significantly higher in meningiomas when compared with the control tissues (p<0.001, p<0.001, p<0.001, p<0.05, p<0.001), respectively., Conclusions: According to our results, the adhesion molecules were found to be higher in meningiomas suggesting that they may be involved in the pathological process of this type of brain tumors. We conceive that developing alternate therapies such as immunotherapeutic approaches against brain tumors might be amendatory in the treatment. Since this is the first study performed in meningioma type brain tumors demonstrating and comparing the levels of various adhesion molecules with control tissues, further clinical and experimental studies are needed to support our current findings with higher number of patients., (Copyright © 2017 Elsevier B.V. All rights reserved.)