Objective This study aims to evaluate the osseointegration of titanium alloy instrumentation commonly used in spinal disorders, which hold significant importance in terms of cost and morbidity, by applying a lanthanum hexaboride(LaB6)-coating—a boron-containing compound selected for its superior mechanical stability and potential osteoinductive properties—using high-resolution ex vivo micro-computerized tomography(micro-CT). This study is structured as a radiological and structural feasibility evaluation to establish a foundation for future translational research. Methods In all, 24-male-rats were randomly selected; LaB6-functionalized titanium alloy(Ti6Al4V) implants prepared by the Physical Vapor Deposition(PVD) method were implanted in 12 rats, while the remaining 12 rats in the control group received Ti6Al4V implants implanted into vertebrae. The degree of osseointegration was evaluated at 1 and 2 months post-implantation using micro-CT analysis based on the Bone-Implant-Contact (BIC) and Bone Volume/Tissue Volume (BV/TV) ratios. Results According to micro-CT analysis, at the end of the 1-month analysis, statistically significant differences were observed in favor of LaB6-coated-implants regarding BIC (P = 0.025) and BV/TV (P = 0.016) values in the vertebrae of the subjects. Similarly, at the end of the 2-month analysis, significant results favoring LaB6-coated-implants were obtained in both BIC (P = 0.037) and BV/TV (P = 0.037) values. Conclusions Traditionally widely used Ti6Al4V implants, when subjected to surface modification with LaB6, have been observed to provide significantly enhanced osseointegration with higher BIC-BV/TV ratios, thus offering a more effective bone-implant interface. In this study, the first of its kind in the field of neurosurgery and spinal implantation, LaB6-modified-implants show promising potential for high osseointegration, suggesting their beneficial use in this area, and further research in this field is warranted.

OBJECTIVE:This study evaluated the surgical efficacy, complication profile, functional outcomes, and cosmetic success of the unilateral supraorbital mini-craniotomy approach in the treatment of large and giant olfactory groove meningiomas. METHODS:In this retrospective study, 20 patients were evaluated. Preoperative clinical and radiological characteristics, details of the surgical technique, Simpson resection grade, complications, postoperative functional status, olfactory function, and follow-up outcomes were examined. All patients were operated using a similar surgical strategy, in which brain relaxation was achieved through cerebrospinal fluid drainage in order to maintain minimal frontal lobe retraction. RESULTS:Simpson Grade 1-2 resection was achieved in the majority of cases (18 patients), whereas planned Simpson Grade 3 resection was performed in 2 patients due to significant comorbidity. The overall complication rate was 5%, with syndrome of inappropriate antidiuretic hormone secretion occurring in only one case, which resolved completely with medical treatment. No cerebrospinal fluid fistula, infection, or permanent neurological deficit was observed. In 10 patients who were anosmic or had reduced olfactory function preoperatively, postoperative olfactory function remained unchanged, whereas postoperative olfactory decline was observed in a limited number of patients with preserved preoperative olfactory function. From a cosmetic standpoint, the short incision aligned with the eyebrow and the minimal bone window provided high aesthetic satisfaction among patients. CONCLUSIONS:Unilateral supraorbital mini-craniotomy is a safe, effective, and low-morbidity minimally invasive approach for the surgical treatment of large and giant olfactory groove meningiomas. High resection rates, a low complication profile, short recovery time, and favorable cosmetic outcomes constitute the major advantages of this technique. Larger, prospective studies will contribute to a more comprehensive evaluation of the long-term oncological and functional outcomes of this approach.

The supraorbital keyhole approach is a minimally invasive technique for treating lesions in the anterior and middle cranial fossa. A major complication of this procedure is injury to the temporal branch of the facial nerve. This study aimed to define safe surgical zones for the lateral borders of the incision to minimize facial nerve injuries. This study examined 15 formalin-fixed adult cadaveric heads (30 sides). The temporal branches of the facial nerve were dissected using a surgical microscope. Three distances were measured using anatomical landmarks: (M1) horizontal distance between the supraorbital notch and facial nerve branches, (M2) vertical distance between the frontozygomatic junction and facial nerve branches, and (M3) horizontal distance between the lateral orbital rim and facial nerve branches. The mean distances were as follows: M1 = 48.96 ± 2.10 mm, M2 = 9.48 ± 0.83 mm, and M3 = 14.80 ± 0.99 mm. All measurements showed significant correlations (p < 0.001). Measurement precision was excellent (TEM 0.14–0.17 mm; rTEM 0.30

Background: Differentiating tumor tissue from normal brain parenchyma during glial tumor resection can be highly challenging. In situations where surgical navigation systems are unavailable and the use of neuromonitoring is limited due to restricted resources, there is a need for affordable and practical alternatives.Aim: we describe a simple technique for delineating the resection margins of low-grade gliomas using bone wax as an intra-cavitary marker in conjunction with magnetic resonance imaging (MRI).Materials and Methods: During tumor resection, small sterile fragments of bone wax were placed within the resection cavity to serve as intra-cavitary fiducial markers. MRI was subsequently performed, allowing real-time visualization of the bone wax positions relative to the surrounding brain parenchyma.Results: Bone wax fiducials provided clear reference points for delineating tumor boundaries and assessing the extent of resection. Surgical margins were determined based on the spatial relationship between the bone wax markers and the residual enhancing tissue, facilitating accurate tumor removal in the absence of advanced neuronavigation systems. Tumor resection was carried out with careful preservation of eloquent cortical and subcortical regions, as identified by preoperative imaging and intraoperative anatomical landmarks.Conclusion: Bone wax represents a practical and cost-effective alternative in resource-limited settings, providing a simple method to minimize navigation system inaccuracies that may occur during surgery. It can be safely and effectively used in centers with limited technical resources.

The supraorbital keyhole approach via transciliary incision represents a minimally invasive surgical corridor that is increasingly applied in pediatric neurosurgery; however, large childhood-specific series remain scarce. This study reports our two-center experience with this approach in a heterogeneous pediatric population. A retrospective analysis was performed of all pediatric patients who underwent surgery via the supraorbital keyhole approach through a transciliary incision at Ankara University and Rome Catholic University between 2017 and 2024. Patient demographics, pathological diagnoses, extent of resection, complications, and clinical outcomes were recorded. The extent of resection was classified as gross total resection (GTR), subtotal resection (STR), or near-total resection (NTR) based on the postoperative MRI findings. Twenty-six patients (mean age, 8.7 years; range, 0.7–17 years) were included in the study. The pathologies included craniopharyngioma (n = 5), cavernous malformation (n = 4), optic pathway glioma (n = 3), pilocytic astrocytoma (n = 2), epidural hematoma (n = 2), frontal abscess (n = 2), and other lesions (n = 8). Among the 20 patients with discrete resectable lesions, GTR was achieved in 11 (55

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.

AIM: To compare the sphenoid ridge (SR) morphology in patients with Chiari type I malformation (CIM) with healthy subjects. MATERIAL and METHODS: Three dimensional (3D) computed tomography scans of 49 (25 men / 24 women) CIM patients aged 45.84 +/- 18.04 years, and 52 (26 men / 26 women) healthy subjects aged 43.46 +/- 11.62 years were included in the investigation. The angulation and dimension of SR were measured for both groups. RESULTS: Compared with the controls, CIM patients had greater lesser wing (LW) length (p<0.001) and LW width in the midline (p<0.001), but shorter LW width in the midpoint (p=0.001), LW width in the lateral point (p<0.001), and LW angle (p<0.001). In CIM, two configurations regarding LW angle types were observed: Type B in 75 LWs (76.5%) and Type C in 23 LWs (23.5%). In controls, two configurations regarding LW angle types were observed: Type A in 35 LWs (33.7%) and Type B in 69 LWs (66.3%). The distribution of the types according to study groups demonstrated that CIM affected significantly LW angle types (p<0.001). CONCLUSION: LW angle and length may represent middle fossa depth and anterior fossa width, respectively; thus, CIM subjects possess shallow middle fossa and wider anterior fossa.

AIM:To determine the prognostic value of routine hematological indices in patients undergoing carotid endarterectomy (CEA). MATERIAL AND METHODS:As a retrospective single center study, we measured the systemic immune inflammation index (SII) and other systemic inflammatory parameters to estimate the morbidity and mortality of patients undergoing CEA. These parameters include inflammatory markers which are included in routine preoperative haematologic tests like complete blood count (CBC). RESULTS:After the analysis of the collected datas from 72 patients, the results showed that inflammatory indices were significantly different in patients with different clinical courses. CONCLUSION:Inflammatory parameters calculated from routine preoperative hematologic parameters proved to be important predictive parameters that can be used in morbidity/mortality estimation of patients scheduled for CEA.

Objectives:The aim of our study is to report optic nerve head (ONH) microvascular changes secondary to intracranial saccular aneurysms, evaluated by optic coherence tomography angiography. Methods:A prospective study was conducted on consecutive intracranial saccular aneurysm patients who underwent neurosurgical intervention and consulted for ophthalmic evaluation at the post-operative period. Comprehensive ophthalmic evaluation, including best-corrected visual acuity, manifest refraction, color vision, pupillary light reflexes, intraocular pressure, slit-lamp biomicroscopy, fundoscopy, and investigation of the function of cranial nerves, was performed. Demographical and clinical data of eyes with intracranial aneurysm (Group 1) were compared to those of age-matched controls (Group 2). In patients with unilateral intracranial aneurysm, microvascular indices of the ipsilateral eye were also compared with those of the contralateral eye. Results:Twenty-eight eyes of 16 patients in Group 1 and 32 eyes of 16 age-matched healthy controls in Group 2 were included in the study. In Group 1, only 1 patient was diagnosed incidentally, whereas the remaining 15 patients were diagnosed after subarachnoid hemorrhage (SAH). ONH microvascular indices were similar in both groups (p>0.05). Both vascular density and thickness were decreased at the nasal inferior sector of ONH in Group 1, compared to Group 2; however, these differences were statistically insignificant. In Group 1, 8 patients have unilateral intracranial aneurysm. Microvascular indices at the ipsilateral eye were statistically insignificantly increased compared to those at the contralateral eye of patients with unilateral intracranial aneurysm. Conclusion:Intracranial saccular aneurysms, associated SAH, or neurosurgical intervention did not seem to cause any significant change in ONH microvascular indices. Further studies with a larger sample size and evaluating intracranial aneurysms located in different anatomical regions will contribute to the interpretation of the present results.

Background and purpose:Neurosurgical approaches in Sylvian arachnoid cysts include microsurgery, endoscopy, and shunting. Yet, their relative safety and efficacy is still under debate. This retrospective study evaluated 36 pediatric patients with Sylvian arachnoid cysts and treated with different surgical types to contribute to global data. Methods:The study included 24, 8, and 4 patients receiving endoscopic, microsurgical, and shunt surgeries, respectively. Preoperative and postoperative assessments included the patients' demographics and symptoms, cyst size and type, psychomotor status, length of hospital stay, and complications with a mean follow-up of 37.3 months. Results:All types of surgeries alleviated headaches and seizures in most of the patients. Shunt operations led to the highest reduction in cyst size in the early postoperative period and relieved cranial palsy in all patients. Microsurgery achieved greater healing regarding hemiparesis and seizures, and reduced cyst size more effectively in the early postoperative period than endoscopy. Complication rates were similar between the endoscopy and microsurgery groups. Conclusion:Arachnoid cyst surgery is efficient and relatively safe. The higher efficacy of microsurgery may be associated with the lesser chronic presence of cysts in this group rather than its technical superiority. Endoscopic surgery is challenging, yet it may be advocated to avoid craniotomy and shunt complications. Surgical-type decisions for arachnoid cysts should be patient-tailored based on careful preoperative clinical and radiological examinations.

Aim: Cervical discectomy followed by cage placement for fusion is nowadays a commonly used method for the treatment of degenerative cervical spine diseases. One of the complications that can be observed during postoperative follow-up is cervical cage subsidence. At this point, it is investigated in this study the relationship between the loss of endplate brightness observed on early postoperative cervical radiographs and the development of cervical cage subsidence during follow-up. Methods: 100 patients who underwent single-level cervical disc herniation surgery between 2013 and 2023 were selected. The patients were divided into two groups based on the presence or absence of cage subsidence in cervical radiographs taken at the 60-day postoperative follow-up. In all patients included in the study, the presence of endplate brightness loss in the cervical radiographs taken within the day 1 of post-surgery period in the vertebrae adjacent to the cage was evaluated and compared between groups. Results: Cage subsidence was detected in 11 patients (11%), while it was not observed in 89 patients (89%). Among the 11 patients with cage subsidence, endplate brightness loss was identified in 8 patients (72.7%), whereas it was found in 10 patients (11.2%) among the 89 patients without cage subsidence. These results indicate a significant relationship between the loss of endplate brightness observed on early radiographs and the occurrence of cervical cage subsidence during later follow-up (p

The present work aimed to classify the pneumatization of the dorsum sellae (DS) in subjects aged 1–90 years. The study consisted of computed tomography images of 1080 subjects (582 males / 498 females), aged 1–90 years (mean age: 45.51 ± 26.06 years). Four different types regarding DS pneumatization were defined as follows: Type 0: no pneumatization, Type 1: pneumatization < 50

This retrospective magnetic resonance imaging investigation aimed to obtain information related to the anatomy of the massa intermedia (MI) in an adult population. The work conducted on MRI views of 1058 (539 males and 519 females) healthy adult samples aged with 48.93 ± 17.63 years. Initially, the presence or absence of MI was noted, and then if present, its numbers and location in the third ventricle were recorded. Its horizontal (HDMI) and vertical (VDMI) diameters were measured on MRI views, while the cross-sectional area (CSAMI) was calculated using its diameters. MI was missing in 2.6

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.

AIM:To assess the frequency of thoracolumbar junction (TLJ) fractures (T10-L2) in survivors of the 2023 East Turkey earthquake.MATERIAL AND METHODS:This single-center retrospective stdy evaluated 10 earthquake survivors, who were trapped under the rubble and rescued alive by rescue teams, and were assessed for spinal trauma after the earthquake in Eastern Turkey on February 6, 2023. All patients underwent full spinal magnetic resonance imaging and computed tomography examinations to determine the level of spinal fracture and decide the treatment methods.RESULTS:All patients had sustained spinal fractures. Eight underwent surgery, while two were managed conservatively. Nine out of ten patients had TLJ fractures. Five patients had L1 fractures, four of them were treated surgically. Three patients had a T12 level fracture, two of whom were treated surgically. One patient with a T7-level fracture was treated surgically. Only one patient had multiple fractures (T12 and L2 levels) and was treated surgically.CONCLUSION:The TLJ was the commonest vertebral fracture level as of the 2023 Turkey earthquake survivors in our study population. In the event of an earthquake, people tend to attain a fetal posture (fix and hyperflex the spine) when taking shelter in a narrow area (triangle of life). This position might place an excessive load on the TLJ, predisposing it to injuries.

To describe the relation of the sphenoid ridge (SR) with the surrounding anatomical structures in healthy children when approaching the anterior and middle fossae. Computed tomography of 180 pediatric patients (90 males / 90 females), aged 1–18 years were included the study. The size of the lesser wing (LW) and the distances of the LW to certain landmarks were measured. The LW length was 28.48 ± 8.15 mm. The LW widths at the midline and the midpoint and lateral point of the SR were 7.78 ± 1.74 mm, 2.84 ± 0.81 mm, and 1.91 ± 0.64 mm, respectively. The distance between the midpoint of the SR and the crista galli was 28.22 ± 5.56 mm, and the distance between the crista alaris and internal auditory meatus was 51.73 ± 5.79 mm. The linear function was calculated as y = 18.748 + 1.024 × age for SR length, y = 6.046 + 0.182 × age for the midline width of SR, y = 2.367 + 0.050 × age for the midpoint width of SR, y = 1.249 + 0.069 × age for the crista alaris width, y = 21.727 + 0.683 × age for the distance between the SR midpoint and the crista galli, and y = 43.614 + 0.855 × age for the distance between the crista alaris and internal auditory meatus. All measured parameters increased irregularly with advancing age. Furthermore, our regression equations representing the growth dynamics of SR may be used to estimate these parameters.

This examination aimed to display the size and topographic position of the Vidian canal (VC) in normal children. 180 pediatric subjects aged 1–18 years were included this computed tomography examination. The distances of VC to certain landmarks, and VC length were measured. The locations of VC according to the sphenoid sinus, and the medial plate of pterygoid process were classified as three types, separately. The distances of VC to the vomerine crest, midsagittal plane, round foramen, and the superior wall of sphenoid sinus were measured as 12.68 ± 3.17 mm, 10.76 ± 2.52 mm, 8.62 ± 2.35 mm, and 14.16 ± 5.00 mm, respectively. The length and angle of VC were measured as 12.00 ± 2.52 mm, and 16.60 ± 9.76°, respectively. According to the sphenoid bone, VC location was identified as Type 1 in 113 sides (47.5