Sinir Sistemi Cerrahisi Dergisi: 7 (2)
Cilt: 7  Sayı: 2 - 2021
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1.
Kapak
Cover

Sayfa I

2.
Danışma Kurulu
Advisory Board

Sayfalar I - III

3.
İçindekiler
Contents

Sayfa IV

4.
Editörden
Editorial

Sayfa V

DERLEME
5.
Cushing hastalığının etyopatogenezinde genomik değişiklikler ve moleküler mekanizmalar
Genomic alterations and molecular mechanisms in the etiopathogenesis of Cushing’s Syndrome
Sera Kayacan, Melek Öztürk, Fatma Kaya Dağıstanlı, Nurperi Gazioğlu
doi: 10.54306/SSCD.2021.16878  Sayfalar 45 - 55
Hipofiz bezinin ön bölümü (adenohipofiz) vücudumuzdaki diğer iç salgı bezlerinin çalışmasını kontrol eden, 5-7 mm büyüklüğünde bir salgı bezidir. Adenohipofiz, çeşitli trofik hormonları salgılamak üzere farklılaşmış hücreler içerir. Bu hücrelerin çeşitli genetik, epigenetik ve çevresel faktörlerle etkileşimi sonucunda çoğunluğu iyi huylu olan hipofiz tümörleri (hipofiz adenomları) ortaya çıkabilir. Hipofiz adenomları arasında tanı ve tedavisi en zor olarak bilinen ACTH-salgılayan adenomlar böbreküstü bezini aşırı uyararak kontrolsüz miktarda kortizol salgılanmasına neden olur. Vücutta yol açtığı değişikliklere Cushing hastalığı adı verilir. Cushing hastalığının USP8, USP48, EGFR, p16, p21 gibi birçok farklı genin işlevinin kaybolmasına bağlı olarak ortaya çıktığı bilinmektedir. Bunun dışında ilgili genlerin metillenmesi ve asetillenmesi gibi çeşitli epigenetik modifikasyonlar ve miRNA’lar gibi çeşitli düzenleyicilere maruz kalması sonucunda da Cushing hastalığı görülmektedir. Bu genlerin ve proteinlerin işlevlerinin belirlenmesi sayesinde yeni tedavi stratejilerinin geliştirilmesi mümkün olacaktır.
The pituitary gland is a 5-7 mm-sized gland that controls the secretion of many different hormones in the body. Pituitary tumors, most of which are benign (pituitary adenomas), may occur as a result of the interaction of different types of cells hosted by the pituitary gland with various genetic, epigenetic and environmental factors. Difficult to diagnose and treatof these pituitary adenomas is Cushing’s disease, which occurs as a result of excessive secretion of cortisol. It is known that Cushing’s disease occurs due to the loss of function of many different genes such as USP8, USP48, EGFR, p16, p21. In addition, Cushing’s disease is seen as a result of exposure to various epigenetic modifications such as methylation and acetylation of related genes and various regulators such as miRNAs. By determining the functions of these genes and proteins, new treatment strategies will be developed and diagnosis and treatment of pituitary tumors will be facilitated.

6.
Parkinson hastalığının hayvan modelleri ve kök hücre temelli deneysel çalışmalar
Animal models of Parkinson’s disease and stem cell- based experimental studies
Gülseli Berivan Sezen, Erdinç Civelek, Serdar Kabataş, Furkan Diren, Tunç Akkoç
doi: 10.54306/SSCD.2021.42204  Sayfalar 56 - 66
Parkinson hastalığı (PH) ikinci en yaygın ilerleyici nörodejeneratif olup, genetik vakalar azınlıkta olup, altta yatan etyopatofizyoloji hala bilinmemektedir. Halen, kanıtlanmış ve kesin bir tedavi mevcut değildir. Yeni terapötik stratejilerin taranması ve test edilmesi için kullanılabilecek güvenilir hayvan modelleri geliştirmek çok önemlidir, mesela, sadece semptomatik tedaviler geliştirmek yerine gerçek patojenik süreci hedefleyen kök hücre tedavileri gibi. Burada, PH’nin güncellenmiş in vivo ve in vitro modellerini özetledik ve bu modelleri kullanarak kök hücre temelli deneysel çalışmaları gözden geçirdik.
Parkinson’s disease (PD) is the second most common progressive neurodegenerative, besides a minority of genetic cases, underlying etiopathophysiology is still unknown. Currently, no proven and exact treatment has existed. It is crucially important to develop reliable animal models that might be used for the screening and testing of new therapeutic strategies e.g., stem cell transplantation targeting the actual pathogenic process as opposed to merely developing symptomatic therapies. Here, we summarized the updated in vivo and in vitro models of PD and reviewed the stem cell-based experimental studies by using these models.

ARAŞTıRMA MAKALESI
7.
Endoskopik üçüncü ventrikülostominin 2 yaş altı hastalarda etkinliği ve başarı oranları
Effectiveness and success rates of endoscopic third ventriculostomy in patients under 2 years old
Murat Ertaş, Derya Karaoğlu Gündoğdu, Mert Şahinoğlu, Ender Köktekir, Hakan Karabağlı
doi: 10.54306/SSCD.2021.08760  Sayfalar 67 - 71
Objective: Endoscopic third ventriculostomy (ETV) stands out as an important option in the treatment of hydrocephalus without shunts. Endoscopic third ventriculostomy (ETV) has become more popular due to recent technical developments in endoscopic systems. But the urge of the physician, to provide a shuntfree survival for his patients, leads to performing the procedure in a unsuitable group of patients. Compared with shunt surgery, ETV presents a more physiological solution for the treatment of hydrocephalus. ETV is accepted as the first-line treatment method in many centers in appropriate cases in the treatment of obstructive hydrocephalus. The aim of this study is to examine the results of patients under the age of two underwent endoscopic third ventriculostomy.
Methods: 79 patients who underwent ETV between 2011 and 2020 in our clinic and who were under 2 years of age at the time of operation were retrospectively analyzed.
Results: 45 of 79 patients were male babies and 34 were female babies. The average age of the patients is 7 months (1 day - 22 months). In 39 (49.3%) patients, there was no need for repeat surgery in their follow-up after ETV. ETV procedure was repeated in 5 (6.3%) patients, and ventriluloperitoneal shunt (VPS) surgery was performed in 2 (2.5%) patients. In 13 patients, ventriculoperitoneal shunt was applied from the anterior and presented with shunt dysfunction. VPS surgery was not performed again after ETV in 3 (23%) of 13 patients after ETV.
Conclusions: ETV can also be applied to patients younger than two years of age, and this treatment can give patients the chance to live a life independent of shunt.
OBJECTIVE: Endoscopic third ventriculostomy (ETV) stands out as an important option in the treatment of hydrocephalus without shunts. Endoscopic third ventriculostomy (ETV) has become more popular due to recent technical developments in endoscopic systems. But the urge of the physician, to provide a shuntfree survival for his patients, leads to performing the procedure in a unsuitable group of patients. Compared with shunt surgery, ETV presents a more physiological solution for the treatment of hydrocephalus. ETV is accepted as the first-line treatment method in many centers in appropriate cases in the treatment of obstructive hydrocephalus. The aim of this study is to examine the results of patients under the age of two underwent endoscopic third ventriculostomy.
METHODS: 79 patients who underwent ETV between 2011 and 2020 in our clinic and who were under 2 years of age at the time of operation were retrospectively analyzed.
RESULTS: 45 of 79 patients were male babies and 34 were female babies. The average age of the patients is 7 months (1 day - 22 months). In 39 (49.3%) patients, there was no need for repeat surgery in their follow-up after ETV. ETV procedure was repeated in 5 (6.3%) patients, and ventriluloperitoneal shunt (VPS) surgery was performed in 2 (2.5%) patients. In 13 patients, ventriculoperitoneal shunt was applied from the anterior and presented with shunt dysfunction. VPS surgery was not performed again after ETV in 3 (23%) of 13 patients after ETV.
CONCLUSIONS: ETV can also be applied to patients younger than two years of age, and this treatment can give patients the chance to live a life independent of shunt.

8.
Perkütan vertebroplasti uygulanan postmenopozal hastalarda osteoporoza eşlik eden sistemik hastalıklar
Systemic diseases accompanying osteoporosis in postmenopausal patients undergoing percutaneous vertebroplasty
Özkan Özger, Necati Kaplan
doi: 10.54306/SSCD.2021.73745  Sayfalar 72 - 77
Amaç: Vertebroplasti ilk kez 1984 yılında vertebra hemanjiomu olan bir hastada uygulanmıştır. Ortalama yaşam süresinin artması osteoporoz olgu sayısındaki artışa paralel olarak vertebral çökme kırıklarının görülme sıklığını da artmıştır. Pediküllerden vertebra gövdesine polimetilmetakrilat (PMMA) enjeksiyonunu içeren minimal invaziv bir tekniktir. Bu çalışmada perkütan vertebroplasti (PVP) uygulanan vertebra kompresyon kırığı (VKK) olan postmenopozal osteoporozlu (PMO) hastalarda eşlik eden hastalıklar ve bu hastalıkların sıklıkları değerlendirildi.
Gereç ve Yöntem: Nöroşirürji kliniğimizde Mayıs 2015-Mayıs 2019 tarihleri arasında PVP uygulanan VKK olan PMO’lu 69 kadın hasta retrospektif olarak gözden geçirildi. Hastaların demografik verileri ile birlikte eşlik eden sistemik hastalıkları hasta dosyalarından kaydedildi.
Bulgular: Çalışmamıza dahil edilen hastaların yaş ortalamaları 73,30 ± 9.09 (49-92 yıl) yıldı. Hipertansiyon, eşlik eden sistemik hastalıklar arasında %39,1’lik oranıyla ilk sırada yer aldı. Sonra azalan sırayla osteoartrit (OA), tip II diyabetes mellitus (DM), gastrointesitinal sistem hastalıkları, kardiyak hastalıklar, serebrovasküler hastalıklar, Alzheimer hastalığı, kronik obstruktif akciğer hastalığı (KOAH), geçirilmiş spinal cerrahi, tiroid hastalıkları, anemi, kronik böbrek yetmezliği (KBY), epilepsi, sigara, glokom, malignite ve depresyon saptandı. Özgeçmişinde özellik olmayan hasta sayısı ise %13’tü.
Sonuç: Ülkemizde ve tüm dünyada özellikle yaşlı popülasyonda sık görülen PMO’un sistemik hastalıklar ve bazı cerrahi müdahalelerle şiddeti artabilir veya tedavisi bozulabilir. Osteoporozdan ve eşlik eden sistemik hastalıklardan korunmak cerrahi girişim uygulamaktan daha önemlidir.
Objective: Vertebroplasty was first performed in 1984 in a patient with vertebral hemangioma. As the average life expectancy increased, the rates of osteoporosis increased, and as a result, the incidence of compression fractures increased. It is a minimally invasive technique involving the injection of polymethylmethacrylate (PMMA) from the pedicles to the vertebral body. In this study, comorbidities and the frequency of these diseases were evaluated in postmenopausal osteoporosis (PMO) patients with vertebral compression fracture (VCF) who underwent percutaneous vertebroplasty (PVP).
Materials and Methods: 69 female patients with PMO who underwent PVP for VCC between May 2015 and May 2019 in our neurosurgery clinic were retrospectively reviewed. The accompanying systemic diseases along with the demographic data of the patients were recorded from the patient files.
Results: The mean age of the patients included in our study was 73.30 ± 9.09 (49-92 years) years. Hypertension, It ranked first among the accompanying systemic diseases with a rate of 39.1%. Then in descending order osteoarthritis (OA), type II diabetes mellitus (DM), gastrointestinal system diseases, cardiac diseases, cerebrovascular diseases, Alzheimer’s disease, chronic obstructive pulmonary disease (COPD), previous spinal surgery, thyroid diseases, anemia, chronic renal failure (CRF), epilepsy, smoking, glaucoma, malignancy and depression were detected. The number of patients with no features in their history was 13%.
Conclusion: The severity of PMO, which is common in our country and all over the world, especially in the elderly population, may increase with systemic diseases and some surgical interventions, or its treatment may be impaired. Prevention from osteoporosis and accompanying systemic diseases is more important than surgical intervention.

OLGU SUNUMU
9.
Spinal intradural endodermal kist
Spinal intradural endodermal cyst
Esin Yiğitbaşı, Nuket Özkavruk Eliyatkın, Varol Aydın, Yelda Özsunar Dayanır
doi: 10.54306/SSCD.2021.40427  Sayfalar 78 - 82
Amaç: Endodermal kistler benign tümörlerin nadir görülen formlarıdır. Bu sunumda, tipik histopatolojik özellikleriyle intradural yerleşimli endodermal kist olgusu olan 35 yaşında bir erkek hastayı sunuyoruz. Bu nadir olgu sunumunda kiste ait epitel hücre farklılıklarının önemini vurgulamayı amaçladık.
Yöntemler: Nöroenterik kistler ve kist döşeyici epiteli hücre tipleri immünohistokimyasal tanı yöntemleri kullanılarak analiz edildi.
Bulgular: Endodermal kistte hücre tipinin önemi vurgulanmış olup goblet-kolumnar epitel bileşeni olan kistlerde nüks sıklığı arttığı bulunmuştur. Bununla birlikte, bir diğer nüks nedeni de tamamlanmamış cerrahi eksizyondur. Bu nedenle, endodermal kistlerin tamamen eksize edilmesi, sadece nüksten kaçınmak için değil, aynı zamanda kist epiteli hücre tiplerini ayırt etmek ve nüks riskini öngörmek için de önemlidir.
Sonuç: Hücre tipinin kesin patolojik tanısı tekrarlama riskini belirler. Beyin cerrahları, kistlerin tam olarak çıkarılmasını sağlamak için ellerinden geleni yapmalıdır.
Purpose: Epithelial cysts of the central nervous system, according to the type of cell origin; neuroepithelial or endodermal type. Endodermal cysts are rare forms of benign tumors. In this presentation, we present a 35-year-old male patient with typical histopathologic features and due to the presence of this rare lesion. We aimed to present this rare case and emphasize the importance of cystic epithelial cell differences.
Methods: Neurenteric cysts, cyst lining epithelium of cell types were analyzed using immunohistochemical diagnostic methods.
Results: The importance of the cell type in the endodermal cyst is also emphasized and the frequency of recurrence in cysts that have goblet-columnar epithelial component. This epithelium is increasing the risk of recurrences. However, the other cause of recurrence is also incomplete excision. Therefore, the complete excision of ECs is important, not only for avoiding recurrence but also for differentiating cell types for ECs and predicting recurrence risk.
Conclusions: The precise pathologic diagnosis of cell type determines the risk of recurrence. Neurosurgeons should exert their best efforts to achieve complete excision of the cysts.

 
 
 

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