FACTORS AFFECTING THE OUTCOME OF SPINE METASTASES: A SINGLE-CENTER EVALUATION IN SURGICALLY TREATED PATIENTS.

BACKGROUND: The estimation of survival is extremely important for metastatic disease in the spine. The aim of this study was to determine the factors affecting the outcome of patients with spinal metastasis, primarily the character of neurological deficit and the histopathology of the tumor. METHOD: A retrospective examination was made of 158 patients with spinal metastasis who were followed up in our clinic between 2010 and 2020 and were underwent surgical intervention. The patients were examined in respect of demographic characteristics, the primary tumor, comorbidities, preoperative-postoperative Visual Analogue Scale scores, preoperative-postoperative neurological examinations and neurological deficit if present and ambulation status, postoperative survival duration, tumor localization, characteristics of the surgeries, complications, the Karnofsky Performance Scale, revised Tokuhashi, and Tomita scores. RESULTS: Spinal metastasis was seen more frequently in males (72,8% male, 27,8% female). Male gender, multiple level involvement, intradural localization, and Karnofsky Performance Scale <70 were seen to cause a shorter survival time. Patients with a primary focus of hematological malignancy, breast cancer, and lymphoma had a longer survival. The revised Tokuhashi, and Tomita scores were observed to be successful in the prediction of survival. A decrease in postoperative Visual Analogue Scale score had a positive effect on functional survival. The absence of preoperative neurological deficit and the patient's ability for preoperative and postoperative ambulation affected survival positively. The overall survival period decreased in patients who were mobilized in the early postoperative period but became non-mobile in the late period, and in those who were non-mobile in both the early and late postoperative periods. CONCLUSION: The neurological and ambulatory status, the Tomita and Tokuhashi scores, intradural localization, and gender are the factors with a significant effect on prognosis.

Increased Neutrophil Lymphocyte Ratio Could be Predictive for Higher Mortality in Preterm Infants with Intraventricular Hemorrhage.

BACKGROUND: The neutrophil-to-lymphocyte ratio (NLR) is a simple, cost-effective index of inflammation that can be measured by peripheral blood count. This study aimed to reveal that a high NLR value could be a prognostic marker for mortality risk in preterm babies born with IVH. METHODS: Preterm babies who had been followed up in the neonatal intensive care unit (ICU) between 2018 and 2020 were included in the study. These patients were examined in two groups, those who had had IVH and those who had not. The patients were evaluated by the week of birth, gender, first-minute APGAR score and NLR obtained from the first postnatal peripheral blood sample. RESULTS: A total of 113 babies had been born preterm and had been treated in the newborn intensive care unit (NICU) were included in the study. Intraventricular hemorrhage (IVH) was observed in 26 (23%) of the infants, and a total of 14 (12.4%) died, with the mortality rate being higher among those with IVH than those without (P = 0.026). There was also a statistically significant difference in the NLR between infants with IVH who died and those who did not (P < 0.001). NLR above 1.5 had 33.7 times higher risk of mortality compared to those with an NLR of 1.5 or below. CONCLUSIONS: This was the first study to examine the relationship between the NLR and mortality in preterm babies with IVH. This study showed that a high NLR was strongly associated with mortality in premature infants with low APGAR scores and having IVH.

Spinal Schwannomas: A Proposal for a New Classification to Aid Surgical Planning.

Background The treatment of spinal schwannomas, which is the most common nerve sheath tumor, is total microsurgical resection. The localization, size and relationship with the surrounding structures of these tumors are crucial in terms of preoperative planning. A new classification method is presented in this study for the surgical planning of spinal schwannoma. Methods All patients who underwent surgery for spinal schwannoma between 2008 and 2021 were reviewed retrospectively, along with radiological images, clinical presentation, surgical approach, and postoperative neurological status. Results A total of 114 patients, 57 male, and 57 females were included in the study. Tumor localizations were cervical in 24 patients, cervicothoracic in one patient, thoracic in 15 patients, thoracolumbar in eight patients, lumbar in 56 patients, lumbosacral in two patients, and sacral in eight patients. All tumors were divided into seven types according to the classification method. Type 1 and Type 2 groups were operated on with a posterior midline approach only, Type 3 tumors were operated on with a posterior midline approach and extraforaminal approach, and Type 4 tumors were operated on with only an extraforaminal approach. While the extraforaminal approach was sufficient in type 5 patients, partial facetectomy was required in 2 patients. Combined surgery including hemilaminectomy and extraforaminal approach was performed in the type 6 group. A posterior midline approach with partial sacrectomy/corpectomy was performed in Type 7 group. Conclusion Effective treatment of spinal schwannoma depends on preoperative planning, which includes correctly classifying tumors. In this study, we present a categorization scheme that covers bone erosion and tumor volume for all spinal localizations.

Factors Associated with Nontraumatic Spontaneous Subdural Hematomas in Pediatric Patients.

OBJECTIVE: In our study, we aimed to summarize the etiology of subdural hematoma that was not traumatic and required operation in pediatric patients. The subdural hematoma characteristics, possible etiologies, and treatment, as well as the patient outcomes, were analyzed. METHODS: A retrospective examination was made of pediatric patients with subdural hematoma who were operated on at Ümraniye Training and Research Hospital. Patients with a history of trauma were excluded. Data on patient sex, age, bleeding location, type of hematoma based on computed tomography imaging, surgical treatment, presenting symptoms, presence of comorbidities, Glasgow Coma Scale, thrombocyte counts, and international normalized ratio values were recorded. RESULTS: Of the 19 patients included in the study, 4 were female and 15 were male. Their ages ranged between 0 and 15 (mean = 5.84) years. In 57.8% of the patients, comorbidities, including acute myeloid leukemia, a history of shunt operation, epilepsy, mucopolysaccharidosis, known subdural effusion, autism, coagulopathy, ventricular septal defect/tetralogy of Fallot, cerebrospinal fluid leakage after baclofen pump administration, Marfan's syndrome, and late neonatal sepsis were present, while 21% had arachnoid cysts and 21% had no reported comorbidities. CONCLUSION: This study suggests that, in pediatric patients with subdural hematoma with an amount of bleeding requiring surgical management, any underlying comorbidities should be investigated regardless of the presence of a history of trauma. While investigating systemic diseases, special attention should be paid to the presence of arachnoid cysts or disruption in cerebrospinal fluid dynamics along with a history of hematologic diseases.