Sinonasal teratocarcinosarcoma (SNTCS) is an extremely rare and highly aggressive tumor. It is characterized by its unique composition, which includes elements of teratoma and carcinosarcoma. Herein, we report a case of SNTCS with intra-cranial extension in a 35-year-old man treated by a multi-disciplinary team. We have retrospectively reported our intra-operative experiences, the pre-operative and post-operative magnetic resonance imaging findings and positron emission tomography findings. The intra-nasal tumor extension was excised by the otolaryngology team after the intra-cranial tumor was excised by the neurosurgery team. The patient was administered adjuvant intensive chemotherapy and radiotherapy at this stage. Our patient has been followed up for 39 months from the time of diagnosis. At 36 months, frontal perilesional oedema with contrast enhancement was identified and confirmed as radiation necrosis on biopsy, while sinonasal recurrence was managed with endoscopic sinus surgery. At the latest follow-up, the patient remains clinically stable. Surgical management of a tumor such as SNTCS involves various nuances. Thus, post-operative management requires a meticulous work routine and team effort. The data gathered may help us identify investigations focused on the clinical and pathological features of SNTCS.

Objective To compare the effects of 3 temporalis muscle dissection techniques—myocutaneous (MC), interfascial (IF), and subfascial (SF)—on surgical freedom during the pterional approach. Methods Eight cadaveric heads were dissected bilaterally (16 sides). The MC, IF, and SF techniques were compared in terms of temporal lobe surface area, surgical freedom volume, and horizontal and vertical angles of attack at 8 predefined target points. Measurements were obtained using Cartesian coordinates acquired with a frameless stereotactic navigation system and analyzed using mathematical modeling. Results The mean temporal lobe surface areas were 14 ± 1 cm2, 18 ± 1 cm2, and 20 ± 1 cm2 for the MC, IF, and SF techniques, respectively. Both IF and SF produced significantly greater temporal lobe exposure than MC (P < 0.001), with SF exceeding IF (mean difference: 2.2 ± 0.3 cm2, P < 0.001). The SF technique also allowed greater posteroinferior mobilization of the temporalis muscle (1 ± 0.2 cm) compared with the IF technique. The MC technique consistently demonstrated the lowest surgical freedom volumes and the narrowest horizontal and vertical angles of attack at the predefined target points (P < 0.05). Compared with IF, the SF technique provided greater surgical freedom volumes and wider horizontal angles of attack across all target points (P < 0.05), whereas vertical angles did not differ significantly. Conclusions SF temporalis muscle dissection was associated with greater surgical freedom and temporal lobe exposure during the pterional approach and may be advantageous when wider operative corridors are required.

Introduction: Prolonged hospitalization following carotid artery stenting (CAS) increases healthcare costs and patient morbidity. Predictive models specific to interventional radiology are lacking. Materials and methods: We retrospectively analyzed patients who underwent CAS between 2012 and 2020. Patients with carotis near-occlusions, underwent cardiac surgery after CAS, bilateral CAS stenting in the same session and patients with missed data were excluded. 386 patients were eligable for the final analyses having pre-follow-up imagings/recordings. A novel scoring system—the Ankara University Risk Analysis and Scoring System—was developed to predict prolonged hospitalization based on clinical and procedural factors. The proposed risk factors used for the assessment were; advanced age(> 80years), symptomatic status, pulmonary disease, elevated creatinine levels, severe contralateral carotid stenosis, longer intervention times and long atherosclerotic plaque(> 2cm)/irregular plaque surface. Results: 87 patients (22.5%) needed prolonged hospitalizations (> 1days) regardless of experiencing any kinds of complications and 30 days neurological complications rates were 4.7% (18patients). 3.1% (12patients) of the patients had non-neurologic and 2.3% (9patients) of the patients had transient complications. A score ≥ 9 identified patients at high risk for complications and extended hospitalization with acceptable sensitivity and specificity values. Besides a more compact scoring system was also proposed with less factors included in the scoring (≥ 3 for prolonged hospitalization, ≥ 4 for complications). ROC analysis demonstrated high predictive performance for both systems (AUC = 0.647–0.730, p < 0.001). Conclusion: Our proposed scoring system shows promise in identifying patients at increased risk for complications and prolonged hospitalization following CAS. Further validation in larger, multi-center cohorts is warranted to confirm its clinical utility.

Odontoidectomy is a challenging technique due to anatomical complexity and complications associated with preferred approaches like transoral–transpharyngeal or posterolateral techniques. The posterior midline transaxis approach offers bilateral access without further complications of anterior approaches and offers craniovertebral instrumentation option at the same session. A CT-based morphometric analysis of 40 cadaveric specimens evaluated with various morphometric parameters, including distances and angles between the base and tip of the odontoid process and the lateral masses, to analyze the surgical corridor utilized in the transaxis odontoidectomy procedure. Toshiba Aquilion CT (Computed Tomography) scanner with 80 detectors at 0.5 mm slice thickness was utilized. Electronic images were generated using 3D (3-Dimension) Slicer software. The specified measurements were conducted on the generated images based on 25 different morphometric landmarks. Key measurements included a PMEP-to-FT distance of 5.21 mm (right) and 6.37 mm (left), PMEP-to-odontoid tip distance of 26.74 mm, and a mean odontoid height of 15.47 mm. Instruments directed from the PMEP should be angled medially at 55° in the axial plane and 16° upward in the parasagittal plane to reach the odontoid base. Odontoidectomy requires detailed anatomical knowledge, extensive training, and precise use of intraoperative navigation systems. Existing studies highlight the posterior midline transaxis approach as morphologically compatible and practical. However, limited research on PMEP angles and distances prompted this morphometric analysis to enhance understanding of the surgical access route and anatomical boundaries.

BACKGROUND AND OBJECTIVES:Robotic surgery systems are commonly used in many surgical fields but currently have limited adoption in neurosurgery. The goal for this work was to share our experience with the da Vinci Xi surgical robot for neurosurgical practice. METHODS:Our senior surgeon (U. E.) underwent robotic surgery training followed by simulation training. Five patients then underwent robotic surgery performed by the surgeon; pathologies included clivus chordoma, odontoid metastatic mass, peroneal neuropathy, and arachnoid cyst. Clinical data, demographic details, and follow-up outcomes were analyzed. RESULTS:Of the 5 patients (2 female, 3 male; mean age, 43 years), 2 had a clivus chordoma, 1 had an odontoid metastatic mass, 1 had peroneal neuropathy, and 1 had an arachnoid cyst. No intraoperative or postoperative neurological deficits or complications were observed. All 5 of the patients had a favorable outcome. CONCLUSION:Robotic systems can offer clear advantages over traditional neurosurgery, particularly for transoral resection and intracranial cyst fenestration. However, practical training is essential for effectively integrating these systems into routine neurosurgical practice. The case series presented here reveals the feasibility of robotic neurosurgery and the need for further evaluation of this technology.

BACKGROUND: The standard treatment for craniopharyngiomas (CPs) involves either initial gross total resection or subtotal resection with adjuvant radiotherapy. However, there is no consensus regarding the management of recurrent cases. We reviewed a series of patients with CP to evaluate the characteristics of patients with recurrent/ progressing CP. METHODS: We retrospectively reviewed 31 patients with biopsy-proven recurrent/progressed CP who were initially operated on at our clinic from 2015 to 2023. Demographic and clinical data, including age, sex, tumor localization, lesion size and features, radiologic findings, and endocrine, neurologic, and ophthalmologic issues, were compared between those with and without recurrence. RESULTS: Fifteen out of 31 patients (48.4%) underwent transnasal/transsphenoidal endoscopic surgery; the remaining 16 underwent microscopic transcranial or neuroendoscopic surgery. After treatment, recurrence, and events (any medical condition related to the patient's current condition other than recurrence) were observed in 48.4% and 32.3% of the cases, respectively. There were no statistically significant disparities between patients with and without recurrence in terms of age, tumor dimensions, tumor localization, gender distribution, surgical modality, or the presence of calcifications or hydrocephalus (P > 0.05). The highest and lowest overall survival was 25 years and 6 months, respectively. CONCLUSIONS: The management of recurrent CP is too complicated to fit into a standard treatment algorithm. Therefore, surgical treatment for these patients should be individualized and planned according to patient symptoms and radiologic findings, which is presumably a more versatile, efficient, and safe approach for recurrent CPs.

OBJECTIVE The aim of this study was to review a series of patients who underwent open cranial surgeries to evaluate the incidence of iatrogenic incisional CSF leaks and discuss its prevention and management. The authors also discuss the utility of the "folding technique" used in duraplasty as an alternative to conventional dural reconstruction techniques. METHODS All patients undergoing open cranial surgery were reviewed, and those with incisional CSF leak were included in this study. CSF leakage was managed using either conservative nonsurgical methods or surgical interventions. When the conservative nonsurgical methods failed to curb the leak, surgical procedures such as lumbar external drainage (LED) using lumbar subarachnoid drainage, external ventricular drainage (EVD), a lumboperitoneal or ventriculoperitoneal shunt (VPS), and reexploration of the surgical site were considered. RESULTS Between 2019 and 2024, 2149 patients underwent open cranial surgeries at our hospital for any cranial pathology; 39 (1.8%) of these patients experienced postoperative incisional CSF leakage. The majority of the pathologies requiring surgeries were located in the supratentorial region (76.9%). Patients were classified according to the type of dural closure technique used. Primary stitching, the patient's fascia, or synthetic dura (resorbable, nonresorbable, or both) were used for dural reconstruction. The median interval between the surgery and the start of the leakage was 19 (IQR 1-79) days in patients with no history of radiotherapy; however, this duration was longer in patients who received radiotherapy (median 45 [IQR 10-540] days). The surgical interventions for CSF leakage were classified as wound resuturing (combined with other conservative approaches such as tightened dressing and elevating the head end of the bed), LED or EVD, or surgical reexploration. The folding technique in duraplasty is a simple way to achieve watertight duraplasty even with autograft or synthetic material. CONCLUSIONS Incisional CSF leakage is a potentially preventable complication with high morbidity. Such cases could be managed via conservative approaches including wound resuturing, LED or EVD, and surgical reexploration. However, the management strategy is beyond any strict algorithm. This folding technique for duraplasty is a worthy replacement for conventional primary suturing for dural repair or reconstruction in cranial and even spinal defects. This study highlights the importance of regaining the watertight nature of the dura in the primary surgery to prevent any further intervention and lower the overall morbidity.

OBJECTIVE: Predicting the aggressiveness of meningiomas may influence the surgical strategy timing. Because of the paucity of robust markers, the systemic immune- inflammation (SII) index is a novel biomarker to be an independent predictor of poor prognosis in various cancers including gliomas. We aimed to investigate the value of SII as well as neutrophil-lymphocyte ratio (NLR) and platelet- lymphocyte ratio (PLR) indices in predicting prognosis. METHODS: Records including demographic, clinical, and laboratory data of patients operated on due to intracranial meningioma in 2017-2023 were retrospectively reviewed. RESULTS: A total of 234 patients were included in this study. All of SII index, NLR, and PLR values at presentation were significantly higher in grade >= 2 meningiomas. A positive correlation was observed between SII index and Ki67 index (r = 0.313; P< 0.001); between NLR and Ki67 index (r = 0.330; P< 0.001); and between PLR and Ki67 index (r = 0.223; P< 0.01). SII index (optimal cutoff level >618), NLR (optimal cutoff level >3.53), and PLR (optimal cutoff level >121.2) showed significant predictive values. CONCLUSIONS: This is the first study to assess the prognostic value of the SII index in patients with intracranial meningiomas. Increased SII index, NLR and PLR were correlated with higher grade and higher Ki-67 index. They also harbor the potential to screen patients that may need more aggressive treatments or more frequent follow-up examinations.

In this case report, we aimed to describe the clinical presentation, surgical approach, and follow-up of a patient with rare anterior meningocele associated with rectothecal fistula. An 17-year-old female patient was admitted to the emergency department with meningitis. On further examinations, an anterior sacral meningocele accompanied by rectothecal fistula was detected. Appropriate antibiotic treatment was arranged and surgical plan was made with the pediatric surgery clinic. The patient underwent meningocele repair via posterior approach and colostomy operation. The patient did not experience any neurological issues after the surgery. The colostomy was reversed 3 months later, and third-month follow-up MRI showed complete regression of the meningocele sac with no neurological complications. Anterior meningocele accompanied by a rectothecal fistula is a rare and complicated case. Only seven cases of coexisting ASM and RTF have been reported in literature. Although both anterior and posterior approaches have been used for the treatment of ASM, the choice of treatment is essentially based on the patient’s clinical and imaging findings.

INTRODUCTION Staphylococcus aureus bacteremia (SAB) can be complicated with metastatic foci as a result of seeding to any body site. It is very important to detect metastatic infections for determining the appropriate treatment modality and duration. Here, we presented a S. aureus bacteremia patient complicated with multiple paravertebral and psoas abscess diagnosed with 18F-fluorodeoxyglucose-positron emission tomography in combination with computed tomography (FDG PET/CT). CASE PRESENTATION A sixty nine year-old male patient presented to the emergency department with hip pain, fever and septic clinical findings. His temperature was 390C, pulse rate was 110 beats/min, blood pressure was 100/70 mmHg. Methicilline sensitive S. aureus growth was detected on all blood cultures. Ceftriaxone treatment started in the emergency room was discontinued and cefazolin was started. Transthoracic, transesophageal echocardiography and abdominal ultrasonography was normal. FDG PET-CT scan was planned to investigate the etiology of fever and identify any metastatic infectious foci. PET-CT imaging revealed that increased metabolic activity in the paraspinal regions at the level of thoraco-lumbar vertebrae, psoas muscle and pubic symphisis. Further imaging directed at the areas identified on PET-CT confirmed the presence of a broad paravertebral abscess and psoas. These abcsess were partially drained by neurosurgery specialists because of multiple and wide area involvement. The patient's treatment was continued with oral amoxicillin clavulonic asit until resolution of abcesses. CONCLUSION Previous studies had shown that 18F-FDG PET/CT had a positive impact on outcome and the management of SAB. Diagnostic PET-CT imaging plays a crucial role in targeted management and timely intervention for SAB.

AIM:To investigate the treatment approaches and follow-up data of patients with pineal region tumours at our institution. MATERIAL AND METHODS:A retrospective study was planned to evaluate patients who diagnosed with a pineal mass between 2019 and 2022 whether incidentally or symptomatically. All patients were evaluated regarding their radiological findings, clinical, labrotary and radiological outcomes of surgery if any performed, intraoperative and postoperative pathological diagnoses, and radiological and symptomatic follow-up results for at least one year. RESULTS:A total of 16 patients were grouped into 2; intervention and conservation groups, respectively. Nine out of 16 patients received intervention (surgery with or without ionising radiation therapy) and remained 7 followed up without intervention. Seven patients in the intervention group were found to have triventricular hydrocephalus, and one had tetraventricular hydrocephalus. Endoscopic approach was the preferred surgical intervention in all operated patients which was conventional endoscopic third ventriculostomy (ETV) via a right-sided frontal burr hole. Five patients required a simultaneous external ventricular drain. Neuronavigation was used in all the procedures. CONCLUSION:Neuroendoscopic intervention is a relatively safe, effective, low-cost initial procedure with low morbidity rates and enables patients to return daily life rapidly. Neuroendoscopy is the best approach for simultaneously providing tissue sampling and diversion of cerebrospinal fluid via ETV or septostomy in hydrocephalic patients with tumours in the pineal region.

ÖzAmaç: Duraplasti, yara yerinin optimal düzeyde iyileşmesi ve olası komplikasyonların önlenmesi adına oldukça önemlidir.Bu çalışmada, duraplastiye yönelik tarafımızca geliştirilen "katlantı tekniğinin" ameliyat sırasında kullanımına dair teknik nüanslara ve söz konusu tekniğin, primer duraplasti-

OBJECTIVE Virtual simulation and imaging systems have evolved as advanced products of computing technology over the years. With advancements in mobile technology, smartphones, and tablets, the quality of display and processing speed have gradually improved, thanks to faster central processing units with higher capacity. Integrating these two technologies into the fields of healthcare and medical education has had a positive impact on surgical training. However, contemporary neurosurgical planning units are expensive and integrated neuronavigation systems in operating rooms require additional accessories. The aim of this study was to investigate the compatibility of smartphone applications in augmented reality (AR)-based craniotomy planning, which can be available even in disadvantaged workplaces with insufficient facilities.METHODS Thirty patients diagnosed with supratentorial glial tumor and who underwent operations between January 2022 and March 2023 were included in the study. The entire stages of the surgical procedures and the surgical plans were executed with neuronavigation systems. The patient CT scans were reconstructed using software and exported as a 3D figure to an AR-enhanced smartphone application. The evaluation of the application's success was based on the spatial relationship of the AR-based artificial craniotomy to the neuronavigation-based craniotomy, with each AR-based craniotomy scaled from 0 to 3.RESULTS In the comparison between neuronavigation-based and AR fusion-based craniotomies, 8 of 30 (26.6%) patients scored 0 and were considered failed, 6 (20%) scored 1 and were considered ineffective, 7 (23.3%) scored 2 and were considered acceptable, and 9 (30%) scored 3 and were considered favorable.CONCLUSIONS AR technology has great potential to be a revolutionary milestone of neurosurgical planning, training, and education in the near future. In the authors' opinion, with the necessary legal permissions, there is no obstacle to the integration of surgical technological systems with mobile technology devices such as smartphones and tablets that benefit from their low-budget requirements, wide-range availability, and built-in operating systems.

OBJECTIVE:This study analyzed organelle toxicities of nanometals applied as free formulations or titanium rod-coating materials in rats. METHODS:All materials were injected intraperitoneally, including the physiological saline applied to the control group. The first experimental group was implanted with nanosilver-coated titanium rods, and the second, third, and fourth groups received free nanosilver at rising levels. The fifth group was implanted with nanosilver, nanocopper, and nanozinc-coated titanium rods, and the sixth group received the same nanometals as free formulations. Light and electron microscopy and ICP-Mass Spectrometry were utilized to determine the neural, hepatic, and renal toxicities and tissue metal levels. RESULTS:In brains, neuropil, myelin, and cellular damages occurred, especially in groups receiving high-dose nanosilver or nanometal combinations. Histiocyte accumulation and dark mitochondria within hepatocytes were discernible in the liver. Kidneys were the organs that were most severely affected by nanometal toxicity. The nephrotoxicity was apparent with the perturbations of the membrane infoldings and mitochondrial damage in the proximal and distal convoluted epithelia. Large angular peroxisomes developed inside the mesangial cells, and Golgi bodies increased in epithelial cells. Systemic metal levels increased on the thirtieth and prominently dropped on the sixtieth day. CONCLUSION:These results provide insights into the extent of injury and organelle targets of nanometals and will guide optimizing the nanomaterials and implants used in the surgical practice.

ve yüzeyel dalları olan peroneal sinirin derin dalı bacak ön kompartmanında bulunan ayak ana dorsifleksörlerini inerve etmektedir

Amaç: Chiari malformasyonları (CM), kraniovertebral bileşke ve arka beynin yaygın