Medium and Long-Term Data from a Series of 96 Endoscopic Transsphenoidal Surgeries for Cushing Disease.

OBJECTIVE: Postoperative data on Cushing's disease (CD) are equivocal in the literature. These discrepancies may be attributed to different series with different criteria for remission and variable follow-up durations. Additional data from experienced centers may address these discrepancies. In this study, we present the results obtained from 96 endoscopic transsphenoidal surgeries (ETSSs) for CD conducted in a well-experienced center. METHODS: Pre- and postoperative data of 96 ETSS in 87 patients with CD were included. All cases were handled by the same neurosurgical team between 2014 and 2022. We obtained data on remission status 3-6 months postoperatively (medium-term) and during the latest follow-up (long-term). Additionally, magnetic resonance imaging (MRI) and pathology results were obtained for each case. RESULTS: The mean follow-up duration was 39.5±3.2 months. Medium and long-term remission rates were 77% and 82%, respectively. When only first-time operations were considered, the medium- and long-term remission rates were 78% and 82%, respectively. The recurrence rate in this series was 2.5%. Patients who showed remission between 3-6 months had higher longterm remission rates than did those without initial remission. Tumors >2 cm and extended tumor invasion of the cavernous sinus (Knosp 4) were associated with lower postoperative remission rates. CONCLUSION: Adenoma size and the presence/absence of cavernous sinus invasion on preopera-tive MRI may predict long-term postoperative remission. A tumor size of 2 cm may be a supporting criterion for predicting remission in Knosp 4 tumors. Further studies with larger patient populations are necessary to support this finding.

Results of Intraoperative Sodium Fluorescein Video Angiography and Its Repeated Use in a Series of Brain Aneurysm Surgeries.

AIM: To present the properities of intraoperative sodium fluorescein video angiography (NaF-V) use in intracranial aneurysm surgery and to discuss the limitations of repeated NaF-V administration. MATERIAL AND METHODS: The clinical findings and imaging results during and after surgery for patients with aneurysm who underwent surgery between September 2020 and June 2022 were examined. NaF-V and micro-doppler imaging were used to control the flow of the parent and perforating arteries and obliteration of the aneurysm dome. The dose of sodium fluorescein administered via the central venous route was 5 mg/kg. RESULTS: Overall, 102 aneurysms were treated during 95 operations in 92 patients. NaF-V was applied at least once in all operations, twice in 17, and thrice in 3 operations. The period between repeated doses of NaF-V ranged from 4 to 50 min. The method allowed for the desired imaging of the parent and perforating arteries in all cases but failed to provide satisfactory results regarding the complete obliteration of the aneurysm dome in three cases. No NaF-V-related complications were encountered in any case. CONCLUSION: Sodium fluorescein is safe, with a high minimum toxic dosage, and provides benefits, even in repeated use, in the evaluation of perforating and parent arteries. NaF-V is effective when used alternatively or in combination with various methods.

Comparison of Sinonasal Complications of Microscopic and Endoscopic Approaches for Transsphenoidal Hypophyseal Surgery: Prospective Study.

AIM: To compare sinonasal complications after microscopic and endoscopic approaches for pituitary adenomas. MATERIAL AND METHODS: At our clinic, sinonasal complications occurred in 31 patients who underwent microscopic transsphenoidal surgery between 2007 and 2014 and in 32 patients who underwent endoscopic transsphenoidal surgery between 2014 and 2016. We statistically compared the complications observed during endoscopic sinonasal examination performed by an otorhinolaryngologist. RESULTS: Sinonasal pathology occurred in 22 of the 31 patients (70.9%) in the microscopy group (Group 1) and 19 of the 32 (59.3%) in the endoscopy group (Group 2). Of the 31 patients in Group 1, 13 had nasal septal perforation, 13 had nasal synechiae, three had anosmia, two had hyposmia and one had saddle nose deformity. In Group 2, no patient had nasal septal perforation, whereas eight had nasal synechiae, one had anosmia, 11 had hyposmia, and 4 had infection. CONCLUSION: There were no statistically significant differences in sinonasal complications (e.g. synechiae, anosmia, deformity, and sinusitis) between the two groups. Although the perforation rate (especially for perforations in the middle portion of the septum) was statistically greater in Group 1 than in Group 2, the hyposmia rate was statistically greater in Group 2 than in Group 1.

Endoscopic Endonasal Transclival Resection of the Upper Clival Meningioma.

In recent years, endoscope use for the excision of brain stem lesions or those localized to the anterior part of the brain stem has started. In this paper, a case of upper clival meningioma resected through the endoscopic endonasal transclival route has been presented with illustrations, and live surgery videos demonstrating the surgery step-by-step. A 35-year-old male patient presented with dysphagia and impaired consciousness. Magnetic resonance imaging (MRI) showed a mass lesion with a wide base located at the clivus and anterior part of brain stem. Following surgical preparations, the mass was resected through the endoscopic endonasal transclival route. Presigmoid and lateral suboccipital approaches are the most popular methods for petroclival tumors. However, the disadvantages are restricted surgical corridor to reach the anterior lesions of the brain stem, and surgical manipulations that should be performed between the cranial nerves to gain access into the pathological structures. The alternative endoscopic endonasal transclival method, which is preferred to reach these lesions anteriorly, does not have these disadvantages. The endoscopic endonasal transclival route is suitable for meningiomas located in the retroclival area. With advances in endoscopic technology and surgical experience, full endoscopic endonasal transclival approach will be an alternative for the treatment of posterior circulation aneurysms, most of the extradural and intradural lesions of the ventral aspect of brain stem, and neuralgia secondary to vascular compression.

Late Postoperative Rhinological Complications After Microscopic Transnasal Hypophysectomy.

AIM: Major complications of microscopic transnasal hypophyseal surgery (MTHS), such as cerebrospinal fluid rhinorrhea, carotid injury, and optic nerve injury, are very rare. However, late rhinological complications can be ignored because they are a minor cause of morbidity compared with major complications. In this study, we extensively examined postoperative rhinological complications in patients who underwent MTHS for pituitary adenoma. MATERIAL AND METHODS: Thirty-one patients diagnosed with pituitary adenoma, who underwent MTHS and whose preoperative nasal examinations were recorded between January 2007 and January 2014, were included in the study. A detailed rhinological examination of the patients was performed. RESULTS: A total of 12 of 31 patients (38.7%) had a perforated nasal septum, and synechiae were detected in the nasal cavities of 13 patients (42%). Anosmia occurred in three patients, hyposmia in two, and a nasal tip deflection and saddle nose deformity were detected in one patient with a perforated nasal septum. No perinasal loss of sense, oronasal fistula, or purulent secretion in the nasal cavity was found in any patient. CONCLUSION: The nasal structures, particularly the nasal septum mucosa, should be treated gently during MTHS. The nasal stages of the operation should be performed with the help of an otolaryngologist until adequate experience is gained.

Antibacterial effect of royal jelly for preservation of implant-related spinal infection in rat.

AIM: Implant-related infections are still a significant problem in spinal surgical procedures. Many drugs and methods have been tried to prevent implant-related infections. Our objective in this study was to evaluate whether royal jelly, which was found to hinder the growth of MRSA, has any preventive role in the prognosis of an infection in rats in an implant-related infection model. MATERIAL AND METHODS: Rats were divided into 3 groups of eight rats. Group-1 consisted of rats that underwent only a spinal implant, group-2 included those rats that were inoculated bacteria together with a spinal implant and group-3 was administered royal jelly in addition to a spinal implant and infection. RESULTS: The amount of bacteria that grew in vertebral columns and implants was more in Group-2 than in Group-3, which meant that the number of bacteria colonies that grew was more quantitatively. This difference was found to be statistically significant in vertebral columns, but not in implants. CONCLUSION: Royal jelly could not fully prevent the MRSA infection in this model, but decreased the severity of infection noticeably. More objective and promising results may be obtained if royal jelly can be used at regular intervals in a different model to be designed with respect to implant-related infections.

Lymphocytic hypophysitis: an underestimated disease affecting the sellar region.

Hypophysitis is an inflammation of the pituitary gland and includes a heterogeneous group of diseases presenting with impaired pituitary gland function. Hundreds of cases have been reported after Goudie and Pinkerton's initial report on a young postpartum woman who died after progressive lymphocytic infiltration of the adenohypophysis in 1962. A 17-year-old woman presented with a three-year history of headache, galactorrhoea and excessive weight gain. The patient had used oral contraceptives for several years until one year previously. Her examination demonstrated only bilateral heteronymous hemianopsia. Laboratory investigation revealed elevated prolactin and decreased gonadotropin levels. Magnetic resonance imaging showed a sellar mass with suprasellar extension. Surgical removal of the lesion was performed via a transsphenoidal approach. A diagnosis of lymphocytic hypophysitis was confirmed by histopathological evaluation. Hypophysitis is an underestimated disease affecting the pituitary gland. Cases are usually diagnosed as adenomas and treated with surgical removal. This case is presented due to the extremely rare infiltration of the pituitary gland by predominantly lymphocytes.

Efficacy of clinical prognostic factors on survival in patients with glioblastoma.

AIM: Glioblastoma is the most common and highest-grade infiltrative astrocytoma. It is usually associated with a bad prognosis. Histological grading is highly predictive of an aggressive behavior, with a mean survival rate of 1 year. Nonetheless, individual patient survival can vary substantially, ranging from 1 month to over 5 years. Several distinct clinical parameters and molecular alterations have recently been described in glioblastoma. The present study compares clinical, radiologic and therapeutic parameters in a series of glioblastomas to identify prognostic factors. MATERIAL AND METHODS: We evaluated 50 cases who were operated on for intracranial glioblastoma between January 1998-March 2004 retrospectively. All clinical records, radiological records and management modalities were evaluated as prognostic value. RESULTS: The mean survival time was 7.5 months (range, 1-18 months). We confirmed the patients' age, gender, Karnofsky Performance Scale score at discharge, postoperative radiotherapy and reoperation as decisive prognostic factors after multivariate analyses. CONCLUSION: We could show that some clinical parameters and treatment modalities were associated with prognosis. Younger age, male gender, higher Karnofsky Performance Score at discharge, total surgical resection, radiotherapy and reoperation were predictor for better prognosis.

Delayed intraventricular tension pneumocephalus due to scalp-ventricle fistula: a very rare complication of shunt surgery.

BACKGROUND: Although pneumocephalus and pneumoventricle are well known entities in neurosurgery practice, delayed intraventricular tension pneumocephalus following shunt surgery is extremely rare. CASE DESCRIPTION: A 60-year-old man presented with vomiting, drowsiness, walking difficulty, urinary incontinence and headache one month after shunt placement for communicant hydrocephalus developing secondary to aneurysmal subarachnoid hemorrhage. Skull X- Rays and Computed Tomography (CT) revealed marked air in both lateral ventricles. Neither physical and neurological examinations nor laboratory studies and cerebrospinal fluid evaluations suggested central nervous system infection. He gradually improved after repairing the scalp incision defect above the previously opened burr-hole and bed rest. CONCLUSION: In contrast to reported cases with delayed pneumocephalus developing after shunting, air entry was in skull base, air source was the scalpventricular fistula in the present case.