The tectal plate can be affected by a broad spectrum of pathological processes, resulting in diverse clinical manifestations. These include primary or metastatic tumors, granulomatous diseases, cerebrovascular malformations, ischemic insults, traumatic injury, lipomas, cysticercosis, and degenerative disorders. However, isolated tectal thickening is typically not regarded as a pathological entity and remains insufficiently investigated. This study retrospectively analyzed the clinical and radiological features of 50 patients presenting to the Ankara University Faculty of Medicine between 2012 and 2023 who exhibited tectal thickening on neuroimaging. The objective was to evaluate the association between tectal thickness and clinical symptoms, as well as related radiological pathologies. Clinical data and imaging findings were assessed to investigate correlations between tectal thickening and conditions such as hydrocephalus, Chiari II malformation, syringomyelia, and cerebral atrophy. Statistical analyses were performed to delineate the clinical significance of increased tectal thickness and to explore its potential role in diagnosis and management. All 50 patients demonstrated tectal thickening, with hydrocephalus identified in 76% of cases. Tectal thickness was significantly greater in patients with Chiari II malformation and syringomyelia. However, tectal thickening did not have a statistically significant effect on the area of the cerebral aqueduct. No association was observed between tectal thickening and visual or auditory symptoms. The risk of malignant transformation was found to be low. This study demonstrates a significant association between increased tectal thickness, hydrocephalus, and specific craniospinal pathologies. These findings suggest that tectal thickening may represent a relevant radiological feature associated with distinct clinical and imaging characteristics, warranting further investigation in larger prospective studies.

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.

AIM:To evaluate the causes and risk factors of seizure recurrence, as well as the outcomes of reoperation in patients who did not achieve sufficient seizure control following surgery for mesial temporal lobe epilepsy (MTLE). MATERIAL AND METHODS:We retrospectively reviewed the hospital charts of patients with medically refractory MTLE who were operated between 1990 and 2021. RESULTS:A total of 240 patients (127 females and 113 males) with medically refractory mesial temporal lobe epilepsy underwent resective epilepsy surgery. Of these, 12 (5%) required reoperation due to seizure recurrence after the initial surgery. Six out of the 12 patients with available seizure outcome data were included in the study. The cause of seizure recurrence in all patients was remnant tissue. The age at reoperation ranged from 17 to 59 years, and the time between the initial and final surgery ranged from 2 to 20 years. The seizure outcome was Engel Class I in all patients, with follow-up periods ranging from 4 to 21 years. CONCLUSION:Surgical failure is still prevalent in patients with MTLE, with inadequate resection frequently serving as the primary cause. Reoperation can considerably improve the seizure outcome. Delaying the opportunity for a second surgical intervention should be avoided.

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 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.

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.

This study aimed to investigate the association between histopathological proliferation markers and microscopic sellar floor invasion in pituitary adenomas treated via endoscopic endonasal transsphenoidal surgery. Specifically, we assessed the predictive value of the Ki-67 proliferation index, Modified Hardy’s Classification, and tumor phenotypes in identifying microscopic invasion. Sixty patients who underwent endoscopic endonasal transsphenoidal surgery between January 2018 and January 2023 were retrospectively analyzed. Data included Ki-67 index, p53 status, ATRX expression, hormonal subtype, MHC grade, and histopathological confirmation of sellar floor invasion. Receiver Operating Characteristic (ROC) curve analysis and multivariate logistic regression were used to determine independent predictors. Microscopic sellar floor invasion was present in 46.7

AIM: To demonstrate the possible use of mixed reality (MR) technology in neurosurgery for multiple purposes, including preoperative planning, training, and three-dimensional (3D) navigation. MATERIAL and METHODS: Using magnetic resonance imaging (MRI) and computed tomography (CT), 3D holographic images of three patients were created and inspected using a remote control. Preoperative planning was performed in a conference room using holographic images. Intraoperatively, the 3D images were matched and the adjacent structures were examined. RESULTS: The MR System (MRS) was a useful tool for preoperative planning and intraoperative navigation during the cranial intervention. It reduces operative time, decreases complication rates, increases surgical success, and enhances surgical outcomes. Eventually, MRS may be more economical. CONCLUSION: The MRS can be used for intraoperative navigation by displaying a 3D hologram at the surgeon's fingertips and for preoperative 3D examination of the lesions and its surrounding structures. The MRS enhances surgical efficacy, reduces healthcare costs, and has a shorter learning curve than the conventional methods. It also enables customized patient-specific surgery.

Endoscopic approaches for skull base pathologies are increasingly being performed, and the subsequent complications, especially in the long term, have also been partially clarified. However, there is no information on the effects of endoscopic endonasal skull base surgeries (EESBS) in children on odor and facial development in parallel with long-term development. We conducted this study to investigate postoperative olfactory function and facial development in pediatric patients who underwent skull base surgery using the endoscopic endonasal method. We evaluated the smell test, sinonasal symptoms, and facial development of pediatric patients who underwent endoscopic endonasal skull base surgery after long-term follow-up. Odor was evaluated using the “Sniffin' Sticks” test kit, which assessed the T (odor threshold), D (odor discrimination), and I (odor identification) parameters. Sinonasal symptoms were evaluated using the SNOT-22 (sinus-nose outcome test) questionnaire. SNA (sella-nasion-A point), SNB (sella-nasion-B point), and ANB (A point-nasion-B point) angles were calculated from maxillofacial tomography and magnetic resonance imaging) to evaluate facial development. Data were compared with those of the healthy control group. We included 30 patients comprising 19 (63.3

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 pneumatization and topographic position of the posterior clinoid process (PCP) in healthy children when approaching the anterior and middle fossae. The study consisted of computed tomography images of 180 pediatric patients (90 males / 90 females), aged 1–18 years. The presence or absence of PCP pneumatization was noted, and the distances of certain landmarks to PCP were measured. The distances of the foramen ovale, foramen rotundum, superior orbital fissure, anterior clinoid process (ACP), foramen magnum and crista galli to PCP were measured as 18.59 ± 3.36 mm, 15.37 ± 3.45 mm, 14.60 ± 3.05 mm, 5.27 ± 3.24 mm, 32.03 ± 3.27 mm, and 30.45 ± 3.93 mm, respectively. These parameters increased with growth (between 1–18 years), but the distance between PCP and ACP decreased with an irregular pattern. In 11 sides (3.10

BACKGROUND:Polymorphous low-grade neuroepithelial tumor of the young (PLNTY) is a rare entity of low-grade neuroepithelial tumors that primarily affects children and young adults. This distinct type of tumor presents unique challenges in diagnosis and management. With its relatively recent identification, researchers and clinicians are striving to understand the characteristics, behavior, and optimal treatment strategies. The symptoms are primarily related to seizures. However, PLNTY can be asymptomatic in some cases. MATERIALS AND METHODS:This is a single-center case report study and a literature review paper. We reviewed a case treated and diagnosed at the Ankara University Faculty of Medicine, Department of Neurosurgery. The demographic data, clinical follow-ups, laboratory, and radiological data of the patients were assessed. RESULTS:We present a 32-year-old male patient who has undergone gross total surgical excision with strict clinical follow-up. Clinical course as well as surgical data of the patient were observed and analyzed. CONCLUSION:On imaging, morphologic resembling and indistinctive clinical course can be nonspecific, contributing to diagnostic uncertainties. This case report was written with the notion that rare diagnoses present an opportunity to understand the progression and patho-oncological factors that can pave the way for better treatment.

OBJECTIVE:To evaluate the position and dimension of the Vidian canal (VC) in Chiari type I malformation (CIM). MATERIALS AND METHODS:Radiologic views of 49 CIM (mean age: 23.58±15.62 y, sex: 23 males/26 females) and 51 healthy subjects (mean age: 42.50±20.12 y, sex: 21 males/30 females) were included in this computed tomography study. RESULTS:In comparison with controls, the VC angle and the distance of the round foramen to VC were greater in CIM, but VC length and the distances of the superior wall of the bony sphenoidal sinus, midsagittal plane, and vomerine crest to VC were smaller in CIM. Relative to the sphenoid bone, the position of VC in CIM was determined as type 1 (59.2%) >type 2 (28.6%) >type 3 (12.2%), whereas in controls as type 1 (54.9%) >type 3 (25.5%) >type 2 (19.6%). Relative to the medial pterygoid plate, the position of VC in CIM was determined as type A (63.3%) >type B (20.4%) >type C (16.3%), while in controls as type B (43.1%) >type A (40.2%) >type C (16.7%). CONCLUSION:VC size and position correlated with CIM. Compared with controls, CIM patients had more partially protruded VC into the bony sphenoidal sinus and more medially located VC according to the medial pterygoid plate.

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.

Introduction: Various perioperative problems occur in patients operated on brain tumors. While many studies focused on the long-term effects of surgery, few focused on the perioperative period. The aim of this study to evaluate clinical and laboratory features and determining the factors which are effecting the outcome in operated patients for brain tumors our pediatric intensive care unit (PICU). Methods: Patients who underwent intracranial tumor surgery in the PICU during the eight-year period were retrospectively screened. Results: Seventy-four patients were included in the study, mean age was 60 (1.5-192) months, and supratentorial tumors were detected in 41 (55.4%) patients. The median length of stay (LOS) in PICU of the patients was 5 (1-150) days. When supratentorial tumor localization, ventriculoperitoneal shunt presence, central venous catheter related bloodstream infection, ventilator-associated pneumonia and other infections were evaluated, a statistically significant difference was found between the two groups when patients’ LOS in the PICU is evaluated in 2 groups of more than 15 days (77%) and less than 15 days (23%). In the postoperative period, diabetes insipidus (DI) in 12 (16%), septicemia in 9 (12%), shunt infection in 8 (10%), hydrocephalus in 7 (9%), seizures in 5 (6%), cranial nerve palsy in 5 (6%) in patients. Conclusion: Neurological sequelae increased with younger age and were more common in patients with infratentorial tumors. While a relationship was found between delta sodium and DI in the postoperative first 4 days, without relationship was found with neurological sequelae.

Objectives: The aim of this study is to evaluate the use of flavum-preserving surgeries in lumbar disc herniation surgery, compare their clinical outcomes with standard microdiscectomy techniques, and demonstrate the transflaval microdiscectomy technique. Material and Methods: Between 2020 and 2023, a total of 48 patients who underwent transflaval microdiscectomy and 48 patients who underwent standard microdiscectomy at a single center were included in the study. Epidemiologic characteristics of the groups were described, and preoperative and postoperative visual analoge scale scores for leg pain (LPVAS) and back pain (BPVAS) were retrospectively analyzed. Results: There is no significant difference between the groups in preoperative mean LPVAS scores (p=0,474) and there is no significant difference between the groups in postoperative mean LPVAS scores (p=0,598). There is no significant difference between the groups in preoperative mean BPVAS scores (p=0,608). However there is a significant difference between the groups in postoperative mean BPVAS scores (p