Effect of Intrathecal Eugenol on Cerebral Vasospasm in an Experimental Subarachnoid Hemorrhage Model.

BACKGROUND: Eugenol has various curative properties. It affects the dilatation of cerebral arteries through voltage-dependent Ca2+ channel inhibition. This study is the first to explore the impact of eugenol on neuroprotection and vasospasm in an experimental subarachnoid hemorrhage (SAH) model. METHODS: Twenty-four adult male Sprague-Dawley rats were indiscriminately separated into 3 groups: the control group (n = 8), the SAH group (n = 8), and the eugenol group (n = 8). A double-bleeding method was used. The eugenol group received intracisternal eugenol (Sigma-Aldrich, St. Louis, MO, USA) at 30 µg/20 µl after induction of SAH. On the day 7, all groups were euthanized. Measurements were taken for basilar artery wall thickness, lumen diameter, serum endothelin-1 (ET-1), and caspase-3 levels. RESULTS: The eugenol group exhibited significantly lower wall thickness, ET-1, oxidative stress index, and caspase-3 levels compared to the SAH group. In comparison to the control group, the eugenol group showed a higher oxidative stress index along with higher ET-1 and caspase-3 levels, but these differences were not statistically significant. Wall thickness was significantly higher in the eugenol group than in the control group. CONCLUSIONS: This study represents the first literature exploration of intrathecal eugenol's impact on vasospasm induced after experimental SAH. Administration of intrathecal eugenol demonstrates a positive effect on the treatment of experimental vasospasm as well as on the reduction of oxidative stress and apoptosis.

Tissue Expressions of Regulatory Enzymes of the Krebs Cycle in Low- and High-grade Gliomas.

AIM: To compare tissue levels of the regulatory enzymes related to the Krebs cycle between low, and high-grade supratentorial gliomas. MATERIAL AND METHODS: Forty patients who underwent surgery for supratentorial gliomas (19 with low-grade and 21 with high-grade gliomas) were evaluated. The regulatory enzymes directly involved in the Krebs cycle, namely pyruvate dehydrogenase, citrate synthase, ?-ketoglutarate dehydrogenase, and isocitrate dehydrogenase, and two enzymes that indirectly regulate the Krebs cycle, namely glutamate dehydrogenase and glutaminase, were quantitatively studied in tumor tissues using ELISA. The results were compared between the two groups. RESULTS: The levels of all enzymes were higher in the high-grade glioma group but only pyruvate dehydrogenase, citrate synthase, and isocitrate dehydrogenase levels showed statistical significance. Moreover, all enzymes showed higher tissue levels in grade- II compared to grade-I gliomas, but only two enzymes, glutamate dehydrogenase and glutaminase, reached significantly higher levels. In the high-grade glioma group, all enzymes again showed higher tissue levels in grade-IV gliomas than in grade-III gliomas, but none showed statistical significance. CONCLUSION: Regulatory enzymes of the Krebs cycle are increased in high-grade gliomas compared to low-grade gliomas. Glutaminolysis enzymes, namely glutamate dehydrogenase and glutaminase, which are required for resupplying the Krebs cycle, are also increased in order to meet the high energy demand in high-grade gliomas.

Tissue and plasma free amino acid detection by LC-MS/MS method in high grade glioma patients.

PURPOSE: The changes in serum amino acid profiles are evaluated in different types of cancers and screening tests were developed for estimating the risk of cancer by rapid analysis of plasma free amino acid (PFAA) levels. There is scarce evidence about the metabolomics analysis of PFAA in malignant gliomas. The aim of the present study was to identify the most promising diagnostic amino acid biomarkers that could be objectively measured for high-grade glioma and to compare their level with the tissue counterpart. METHODS: In this prospective study, we collected serum samples from 22 patients with the pathological diagnosis of high-grade diffuse glioma according to WHO 2016 classification and 22 healthy subjects, and brain tissue from 22 controls. Plasma and tissue amino acid concentrations were analyzed applying liquid chromatography-tandem mass spectrometry (LC-MS/MS) method. RESULTS: Serum alanine, alpha-aminobutyric acid (AABA), lysine (Lys) and cysteine concentrations were significantly higher in high-grade glioma patients despite low levels of alanine and Lys in the tumor tissue. Aspartic acid, histidine and taurine were significantly decreased in both serum and tumors of glioma patients. A positive correlation was detected between tumor volumes and serum levels of latter three amino acids. CONCLUSION: This study demonstrated potential amino acids which may have diagnostic value for high-grade glioma patients by utilizing LC-MS/MS method. Our results are preliminary to compare serum and tissue levels of amino acids in patients with malignant gliomas. The data presented here may provide feature ideas about the metabolic pathways in the pathogenesis of gliomas.

Surgical Treatment of Far Lateral Lumbar Disc Herniation: Outcomes of the Safe and Simple Midline Approach.

Objective Surgery for far lateral lumbar disc herniation (FLLDH) hernias is different than surgery for median and paramedian disc hernias. Our study offers a minimally invasive surgical technic for far lateral disc herniations. Methods The results of the midline surgical approach in 18 patients diagnosed with FLLDH were evaluated retrospectively. Results A total of 18 patients (7 females, 11 males), with a mean age of 57.9±9.4 years (range: 35-71 years), were included in the analyses. Three patients (16.7%) had lesions at the left L3-L4 level, six patients (33.3%) on the left L4-L5 level, five patients (27.8%) on the right L3-L4 level, and four patients (22.2%) on the right L4-L5 level. All patients had low back and leg pain. These complaints completely regressed after surgery. Conclusion This study presents a review of a consecutive series of patients who underwent minimally invasive surgery for FLLDH using a midline approach.

Measuring the shape and dimensions of normal the bony structures in the craniovertebral junction from computed tomography images of the pediatric age group.

BACKGROUND: The aim of this study is to contribute to the literature by determining the morphometric reference values of the bony structures in the craniovertebral junction (CVJ) from computer tomography (CT) images of the pediatric age group. METHODS: In this study, CT's of 151 simple trauma patients aged between 3 and 15 years between 2016 and 2020 were evaluated. All CT examinations were performed using a 32-slice CT and included images of the skull base and C1-C2 junction. A total of 10 measurements were obtained from these images, including Wachenheim clivus canal angle (WCA), Welcher basal angle (WBA), Cran-iocervical tilt angle (CCT), power ratio (PR), Atlantodens interval, McRae Line (MRL), McRae - Dens distance, basion-dens interval (BDI), basion-axis interval (BAI), and atlantooccipital measurement (AOM). RESULTS: In comparison between gender groups, MRL (p=0.011) and AOM (p<0.001) measurements were found to be significantly higher in males. McRae-Dens distance, BDI, and AOM were significantly higher in patients aged 3-9 years (respectively, p=0005, p=0.003, p<0.001), and BAI (p=0.001) was significantly higher in patients aged 10-15 years. The McRae - Dens distance (p=0.119) was similar between patients with and without terminal ossicle in odontoid apex. But BDI of patients without terminal ossicle was significantly higher (p=0.048). All parameters, except the WCA, WBA, CCT, and PR, were statistically significantly correlated with the patient age (respectively, p=0.21, p=0.13, p=0.70, p=0.99). CONCLUSION: In this study, the morphometric reference values of the bone structures at the CVJ were determined from the CT images of the pediatric age group.

Circulating Levels of Thrombospondin-1 and Thrombospondin-2 in Patients with Common Brain Tumors.

AIM: To measure serum levels of thrombospondin-1 (TSP-1) and thrombospondin-2 (TSP-2) in patients with common brain tumors, namely high-grade glioma (HGG), low-grade glioma (LGG), and meningioma. MATERIAL AND METHODS: For this prospective study, a total of 56 patients were operated on for supratentorial gliomas and meningiomas, and 18 healthy subjects were evaluated. Serum levels of angiostatic molecules were measured with enzyme-linked immunosorbent assay. The results of patients were compared with those of healthy subjects. RESULTS: High serum levels of TSP-1 were seen in HGG, followed by LGG, meningioma groups, and controls. The only significant difference was found between HGGs and controls (p=0.004). There was a trend to decrease from HGG to controls. High serum levels of TSP-2 were seen in controls, followed by meningioma, LGG, and HGG. None of the patient groups showed significant differences compared with controls. Among the patient groups, TSP-2 was significantly higher in the meningioma group than the HGG group (p=0.01). No correlation was found with any of the molecules and the clinical parameters, including the presence of peritumoral edema or seizure, the anterior-posterior diameter of the tumor, and, more importantly, the grade of glioma. CONCLUSION: Our results indicate that TSP-2 might be more important than TSP-1 in preventing angiogenesis and a major angiostatic factor in glioma cells.

Health-related Quality of Life Assessment in Patients with Malignant Gliomas.

BACKGROUND: High-grade gliomas have limited time of survival despite aggressive treatment. Patients experience a decline in their physical and mental capacities, affecting their quality of life (QoL), and require proper therapeutic strategies. OBJECTIVE: To assess the QoL of malignant glioma patients before and after the treatment in a longitudinal study of six months. METHODS AND MATERIAL: Forty-nine patients who were pathologically diagnosed with glioblastoma and anaplastic glioma according to WHO 2016 were included in this prospective study. The assessment of quality of life was done using the European Organization for Research and Treatment of Cancer (EORTC) quality of life (QoL) questionnaire core-30 prior to surgery, 1 and 5 months after the operation. RESULTS: The decline in Karnofsky scores of the patients was statistically significant. Among the symptom scales, fatigue was more prominent after surgery while pain was noticeable during chemotherapy which was correlated with increased age. The mean overall QoL scores showed a clinically significant decline during the postoperative period. The functional scores demonstrated a significant decline in between all periods. Sex was significantly correlated with preoperative emotional and physical functioning. The patients with right-sided lesions had higher mean scores for social and cognitive functioning. CONCLUSIONS: Low KPS, older age, and female gender may affect cancer symptoms and physical and social activities in malignant glioma patients. Cognitive functions as well as social and occupational roles gradually decline during the first six months of treatments. Overall QoL of high-grade glioma patients deteriorates especially after radiotherapy and during the first months of chemotherapy.

Clinical and radiological outcomes of arachnoid-preseving suboccipital decompression for adult chiari I malformation with and without syringomyelia.

OBJECTIVE: To share our experience related to clinic and radiologic outcomes of patients with Chiari I malformation. PATIENTS AND METHODS: This retrospective study evaluated surgical outcome of 48 patients who underwent posterior fossa decompression and duraplasty with arachnoid-preservation technique February 2010 and February 2019. Clinic and radiologic outcomes at long-term follow-up were provided. RESULTS: Surgery led to satisfactory outcomes in both clinic and radiologic measures. The majority of patients (66.7%) in the follow-up period informed us that their symptoms significantly improved. In 14 patients (29.2%), the symptoms were gone totally and no complaining was reported to us. Syringomyelia was encountered in 21 patients (43.7%) on pre-operative MRI. During long-term, significant improvement (syrinx segments were remarkably reduced in diameter) in syrinx size was noted in 16 of the 21 patients (76.1%). In 5 of the 21 patients (23.8), complete improvement, that is, syrinxes were totally collapsed, was seen. Surgery-related complications occurred in a total of 5 patients (10.4%). CONCLUSION: In our experience, we found decompressive craniectomy wide enough with duraplasty without arachnoid opening is safe and successful in patients with CIM. Complication rate is low and arachnoid preserving technique should be performed by experienced neurosurgeons.

Thoracolumbar burst fractures requiring instrumented fusion: Should reducted bone fragments be removed? A retrospective study.

BACKGROUND: Thoracolumbar burst fractures are common clinical entity encountered in neurosurgical practice, accounting for 10-20% of all spinal fractures. Clinical picture could be devastating due to severe neurological deficits which lead the patients dependent both socially and emotionally. MATERIALS AND METHODS: This study compared two groups of patients who were operated because of thoracolumbar burst fracture secondary to spinal trauma in terms of neurologic deficits, degree of improvement, and radiologic measurements at one-year follow-up. The first group (group I) included the patients who underwent posterior total laminectomy, peroperative reduction of intracanal bone fragments, and posterior spinal instrumentation and the second group (group II) included the patients who underwent total laminectomy, and spinal instrumentation without reduction of free bone fragments. RESULTS: Neither group showed significant correlation with any measurement parameter. Radiological assessments and clinical improvements did not disclosed significant difference between the two groups at one-year follow-up. CONCLUSION: Retropulsion of free bone fragments extend the time of surgery and causes complications. This study found that there is no need to retropulse the bone fragments in the spinal canal in patients with unstable burst fractures who underwent total laminectomy and posterior long segment stabilization.

Intraoperative antepulsion of a posterior lumbar interbody fusion cage: three case reports.

Spinal fusion surgery techniques develop together with technologic advancements. New complications are seen as the result of new techniques and these may be very severe due to spinal cord and vascular structures in the lumbar region. The posterior lumbar interbody fusion cage (PLIFC) was shown to enhance spinal fusion and to prevent pseudoarthrosis due to its basic dynamic characteristics. PLIFC migrations are usually observed during the postoperative period, just after the mobilization of the patient and usually toward spinal canal. Migration to the retroperitoneal region is a extremely rare condition in the literature. In this article we discussed three cases of PLIFC antepulsion into the retroperitoneal region during the intraoperative period.

Retrospective, Demographic, and Clinical Investigation of the Causes of Postoperative Infection in Patients With Lumbar Spinal Stenosis Who Underwent Posterior Stabilization.

Owing to the increasing population of elderly patients, a large number of patients with degenerative spondylosis are currently being surgically treated. Although basic measures for decreasing postoperative surgical infections (PSIs) are considered, it still remains among the leading causes of morbidity and mortality. The aim of this retrospective analysis is to present possible causes leading to PSI in patients who underwent surgery for lumbar degenerative spondylosis and highlight how it can be avoided to decrease morbidity and mortality. The study included 540 patients who underwent posterior stabilization due to degenerative lumbar stenosis between January 2013 and January 2014. The data before and after surgery was retrieved from the hospital charts. Patients with degenerative lumbar stenosis who were operated upon in this study had >2 levels of laminectomy and facetectomy. For this reason, posterior stabilization was performed for all the patients included in this study. Determining the causes of postoperative infection (PI) following spinal surgeries performed with instrumentation is a struggle. Seventeen different parameters that may be related to PI were evaluated in this study. The presence of systemic diseases, unknown glove perforations, and perioperative blood transfusions were among the parameters that increased the prevalence of PI. Alternatively, prolene sutures, double-layered gloves, and the use of rifampicin Sv (RIS) decreased the incidence of PI. Although the presence of systemic diseases, unnoticed glove perforations, and perioperative blood transfusions increased PIs, prolene suture material, double-layered gloves, and the use of RIS decreased PIs.

Low-grade temporal gliomas: surgical strategy and long-term seizure outcome.

Low-grade gliomas (LGGs) are generally located in temporal lobe and cause medically-intractable seizure so that surgical treatment becomes inevitable. This study includes a retrospective analysis of our patients with temporal LGGs retrieved from our epilepsy surgery data base and tries to present appropriate surgical approach and long-term seizure and anti-epileptic drug (AED) outcomes. Fifty-three patients including children and adults underwent surgery on temporal lobe LGGs and 35 patients were reached to report seizure and AED outcomes. On the non-dominant temporal lobe, anterior temporal resection with hippocampectomy whether mesial structure are involved or not is the appropriate approach. On the dominant temporal lobe mesial structures should be respected. However, total resection of the tumor should be the goal of surgery. Mean follow-up period was 8.3 years and favorable seizure outcome was found to be 91.4%. Surgery decreased AED usage and mean number of AED significantly decreased. Children also benefited from surgery as adults. Surgical treatment of tumor-related epilepsy from temporal lobe controls seizures, and total removal should be the main goal of surgery as neuropsychological testing permit.

Aneurysmal bone cysts of the spine: two case reports.

Aneurysmal bone cysts are rare entities which causes expansile and destructive bone lesions characterized by reactive proliferation of connective tissue. They usually grow rapidly with hypervascularity. In clinical practice they can be easily misdiagnosed due to the rare occurance and having no such typical findings as radiologically. Most cases have uncommon pain symptoms, but rarely, if fractures occur, neurological findings can be seen and the surgical treatment, if needed, could be difficult. We will discuss our evaluations to two cases that we experienced in our clinic in this report.

Tissue and plasma thioredoxin reductase expressions in patients with glioblastoma multiforme.

BACKGROUND AND STUDY AIMS: Thioredoxin reductase (TrxR) is a redox protein that is considered to play a role in tumor progression. The purpose of this study was to assess the expression of TrxR in blood and tumor samples of glioblastoma multiforme (GBM) patients. PATIENTS: TrxR levels were evaluated in blood and GBM tissues extracted from 27 patients, in normal brain tissues of 12 autopsy cases, and in blood samples of 12 healthy subjects. The results were compared between tumor and control groups. RESULTS: The mean level of TrxR in GBM tissues (74.5 ± 14.9 U/g wet tissue) was remarkably higher than in normal brain tissues (14.8 ± 3.4 U/g wet tissue). The mean TrxR levels in blood were significantly higher in GBM patients (296.3 ± 43.6 U/mL) than in the controls (203.0 ± 11.3 U/mL). CONCLUSIONS: These findings suggest that high levels of TrxR may be related to progression of GBM.

Expressions of some vital molecules: glioblastoma multiforme versus normal tissues.

OBJECTIVE: The aim of this study was to assess plasma and/or tissue levels of adhesion and apoptotic molecules, cytokines, nitric oxide metabolites, levels of lipid peroxidation, myeloperoxidase and superoxide dismutase in patients with glioblastoma multiforme and controls. METHODS: All the molecules were evaluated in 25 tumors and 30 controls: 15 were normal healthy subjects for plasma and 15 were normal brain tissues that were collected during autopsy. Commercially available kits for measurements were used. RESULTS: Superoxide dismutase was significantly lower in tumors, while all other molecules were significantly elevated compared to the controls (p=0.0001). Superoxide dismutase negatively correlated with plasma interleukin-1beta (p=0.04) and plasma Fas (p=0.016). Plasma intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 correlated positively with plasma 3-nitrotyrosine (p=0.019) and nitrite/nitrate (p=0.019), respectively. Furthermore, plasma interleukin-1beta also positively correlated with plasma nitrite/nitrate (p=0.003). DISCUSSION: These results suggest that there is a complex relationship between pro- and anti-apoptotic molecules in glioblastoma multiforme pathogenesis. Thus, targeting multiple pathways with advanced chemotherapeutic agents or radiotheraupetic regimens following total resections might be helpful in patients with glioblastoma multiforme since preventing a single pathway does not seem to be reasonable.

Expression of hypoxia inducible factor-1alpha in tumors of patients with glioblastoma multiforme and transitional meningioma.

Hypoxia-inducible factor-1 alpha (HIF-1alpha) is the major transcriptional factor involved in the adaptive response to hypoxia. The aim of this study was to assess HIF-1alpha in 22 patients with transitional meningioma (TM) and 26 patients with glioblastoma multiforme (GBM). HIF-1alpha was assessed using a commercially available enzyme-linked immunosorbent assay-based HIF-1 transcription factor assay. Levels of HIF-1alpha in TM and GBM were measured using optical density at 450nm, and median values were found to be 0.35 for TM and 0.37 OD for GBM, respectively. There was no statistically significant difference between the two types of tumor (p=0.264). These findings indicate that HIF-1alpha is elevated in both TM and GBM, suggesting that although hypoxia is one of the most important and powerful stimuli for HIF-1alpha elevation and consequently angiogenesis, other mechanisms may play roles in HIF-1alpha stimulation in benign brain tumors such as TM.

Epidermoid tumour within the collateral sulcus: a rare location and atypical presentation.

Epidermoid tumours (ETs) are uncommon benign lesions that may grow by spreading in the subarachnoid space of the basal cisterns and expanding to conform to the shape of specific sulci and fissures. A temporobasal location is very rare, and there have been no reports regarding single sulcus involvement of ETs. We describe the case of an ET located on the basal surface of the temporal lobe, predominantly within the collateral sulcus, which separates the parahippocampal gyrus medially from the fusiform gyrus laterally. We report the case of a 25-year-old woman with complex visual hallucinations. MRI of the brain revealed a right temporobasal mass lesion, hypointense on T(1)-weighted and hyperintense on T(2)-weighted images, with minimal contrast enhancement, on the basal surface of the temporal lobe. Right-sided anterior temporal lobectomy, along with microsurgical removal of the collateral sulcus ET were performed with consequent resection of mesial temporal structures (the region of the hippocampus, parahippocampal gyrus, and amygdala). It is important to consider ETs when treating lesions on the basal temporal lobe, since the inferior surface of the temporal lobe, more specifically the collateral sulcus, may be a convenient space for ETs to localize. Total surgical resection should be the goal in these cases; however, the surgical approach may be tailored to include the resection of mesial temporal lobe structures when seizure is the predominant presenting symptom.

Elevated cerebrospinal fluid and serum YKL-40 levels are not associated with symptomatic vasospasm in patients with aneurysmal subarachnoid haemorrhage.

YKL-40 is a newly discovered matrix protein that is thought to be released during the acute stages of inflammation. It has recently been speculated that YKL-40 may serve as a specific serological marker of neutrophil function at the site of tissue inflammation. Our aim was to determine whether the levels of YKL-40 in both the cerebrospinal fluid and sera of 22 patients with aneurysmal subarachnoid haemorrhage were associated with either vasospasm or outcome. The levels were also compared with those of 16 control patients with hydrocephalus. We found that patients with aneurysmal subarachnoid haemorrhage had significantly higher YKL-40 levels in both cerebrospinal fluid and serum than controls. However, elevated YKL-40 levels were not associated with symptomatic vasospasm or 6-month outcome. We show that elevated YKL-40 levels are not correlated with the severity of subarachnoid haemorrhage and cannot be used as a serological marker of inflammation in patients with an aneurysm rupture.

Cerebrospinal fluid and serum chitotriosidase levels in patients with aneurysmal subarachnoid haemorrhage: preliminary results.

AIM: The purpose of this study was to investigate the time course(s) of the cerebrospinal fluid and serum chitotriosidase changes in patients with aneurysmal subarachnoid hemorrhage and to show whether cerebrospinal fluid and/or serum chitotriosidase levels might be used as a specific marker for disease severity. MATERIAL AND METHODS: Chitotriosidase in the cerebrospinal fluid and serum was measured within the first 3 days, at Day 5 and at Day 7 after aneurysmal subarachnoid hemorrhage in 20 patients, and the results were compared to 8 patients with normotensive hydrocephalus. RESULTS: Mean cerebrospinal fluid chitotriosidase levels were found to be higher on days 5 and 7 of subarachnoid hemorrhage and the serum levels were always higher than controls at all times in subarachnoid hemorrhage patients. However, no relationship was found between elevated chitotriosidase levels and the clinical parameters including symptomatic vasospasm and outcome at 6 months. CONCLUSION: Results indicate that chitotriosidase is elevated in the acute stages of subarachnoid hemorrhage but is not a specific marker of subarachnoid hemorrhage severity.

Relationship between DNA damage and total antioxidant capacity in patients with transitional meningioma.

PURPOSE: The purpose of this study was to assess oxidative DNA damage and total antioxidant capacity (TAC) in patients with transitional meningioma (TM) and to compare the results with normal brain tissues. PATIENTS AND METHODS: Oxidative DNA damage and TAC were evaluated in TM extracted from 22 patients and in normal brain tissues of 15 subjects who underwent autopsy within first 4h of death. Oxidative DNA damage was assessed by measuring 8-hydroxy-2-deoxyguanosine (8-OH-dG) using the 8-OH-dG enzyme immunoassay kit, a quantitative assay for 8-OH-dG, and TAC was analyzed using the ImAnOx colorimetric test system for the determination of antioxidative capacity. The results were compared between two groups and any correlation between 8-OH-dG and TAC was sought. RESULTS: The median level of TAC in TM (135nmol/gwet tissue) was remarkably lower than in normal brain tissue (298nmol/gwet tissue). The difference was statistically significant (p=0.00001). In contrast, oxidative DNA damage was significantly higher in patients with TM (71.61ng/gwet tissue) than in controls (34.71ng/gwet tissue). Again, the difference was statistically significant (p=0.00001). We also found a negative correlation between oxidative DNA damage and TAC (p<0.001). CONCLUSION: These findings show that the degree of oxidative DNA damage is increased and TAC is decreased in TM and oxidative DNA damage is negatively correlated with the levels of TAC.