Factors affecting medical students' satisfaction with online learning: a regression analysis of a survey.

BACKGROUND: Medical education requires the implementation of different teaching methods and strategies for future doctors to achieve broad learning objectives. This wide range of methods and strategies includes the use of Information Technologies. For a long time, there was a call for a change in medical education for blending new teaching approaches to lessen medical students' class time. The COVID-19 pandemic then sped up the transition to the new way of medical education and classroom lectures were quickly moved to a virtual environment. We expect that these changes will continue, and online learning will be one of the main teaching strategies in medical education. Therefore, educational experiences during the COVID-19 pandemic will improve our understanding of online learning and will help to develop blended medical school curricula in the future. For this reason, we aimed to determine students' overall satisfaction with their online learning experience and to define the main factors affecting students' satisfaction with their online learning program at Cerrahpasa Medical Faculty. METHODS: A cross-sectional survey study was conducted to determine medical students' overall satisfaction with online learning methods and to identify factors associated with positive and negative satisfaction levels. A questionnaire, consisting of 24 questions to collect demographic characteristics, factors associated with online education experience and overall satisfaction levels was developed and distributed to 1600 medical students. Multivariable linear regression analysis was used to determine the factors associated with positive and negative satisfaction levels. RESULTS: Regression analysis showed that being familiar with online teaching techniques (ß = 0.19, 95% CI [0.07, 0.30], faculty members' higher online teaching skill levels (ß = 0.42, 95% CI [0.32, 0.51], interactive online teaching approaches (ß = 0.54, 95% CI [0.41, 0.67], having a personal workspace (ß = 0.43, 95% CI [0.19, 0.67], and a self-reported longer attention span (ß = 0.75, 95% CI [0.57, 0.92] were associated with higher overall satisfaction with online learning. The occurrence of technical problems (ß = -0.19, 95% CI [-0.26, -0.12] was associated with lower overall satisfaction. CONCLUSIONS: Higher online teaching skills of faculty members, use of interactive approaches, students' familiarity with online teaching techniques, provision of a personal workspace, and self-reported longer attention spans positively contributed to higher levels of student satisfaction with online learning. Considering the increasing significance of online educational methods, our study identified key components that affect students' level of satisfaction. This information might contribute to the development of online educational programs in the future.

A new ventricular index based on coronal brain magnetic resonance images in patients with idiopathic normal pressure hydrocephalus.

BACKGROUND: The aim of this study was to assess the effectiveness of a new quantitative index for the diagnosis of idiopathic normal pressure hydrocephalus. METHODS: This retrospective study was conducted at Istanbul University Cerrahpasa Medical Faculty between January 2016 and November 2022. A total of 31 patients diagnosed with idiopathic normal pressure hydrocephalus were included in the study group and 48 patients were included in the control group. Measurement via the new Index was performed on a coronal section of magnetic resonance imaging at the level of the anterior commissure. RESULTS: The new Index's mean diagnostic performance was 1.16 ± 0.08 in the study group, significantly lower (p < 0.0001) than the mean of 1.43 ± 0.10 in the control group. When a cutoff value of 1.23 was used for the new index, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rates were 96.1%, 90.7%, 80.6%, 98%, and 91.3%, respectively. DISCUSSION: The new Index described here is an effective, feasible, reproducible, highly sensitive, and specific quantitative method that can contribute to the improved diagnosis of patients with idiopathic normal pressure hydrocephalus.

Endoscopic Endonasal Transethmoidal Approach for the Management of a Traumatic Brain Abscess and Reconstruction of the Accompanying Anterior Skull Base Defect.

Skull base endoscopy in the treatment of brain abscesses has been rarely published. Moreover, endoscopic endonasal transethmoidal approach (EETA) for the treatment of brain abscess following a head trauma has been reported only in a few case reports. We report the management of a patient of intracerebral abscess and reconstruction of the accompanying anterior skull base defect through an EETA.Thirty-year-old male with a frontal lobe abscess due to a penetrating skull base trauma was operated via EETA. After drainage of the abscess, dural and bony defects were repaired to prevent any recurrence. Postoperative radiological imaging revealed prominent decrease in abscess size. The patient did not need any further surgical intervention, and antibiotherapy was adequate.EETA is safe and effective in the management of brain abscesses. Skull base endoscopy provides direct visualization of the abscess cavity through a minimal invasive route, facilitates wide exposure of surrounding neurovascular structures within the operative field, and enables concurrent closure of the skull base defect.

Association between FAS and FASL genetic variants and risk of primary brain tumor.

The purpose of this study was to investigate whether functional polymorphisms of apoptosis pathway genes FAS and FASL are associated with the development of primary brain tumors. The study constituted 83 patients with primary brain tumor and 108 healthy individuals. In the present case-control study, the primary brain tumors were divided into two groups: gliomas and meningiomas. Evaluation of FAS -1377 G/A and FASL -844 T/C gene polymorphisms were performed by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). To confirm the genotyping, results were examined by DNA sequencing method. Our results were analyzed by SPSS. The frequency of the FAS -1377 AA genotype was significantly lower in meningioma and glioma patients compared to controls (p = 0.023; p = 0.001, respectively). Multivariate logistic regression analysis revealed that FAS -1377 AA genotype was associated with decreased risk of meningioma and glioma (OR = 0.092, 95% CI: 0.012-0.719, p = 0.023 for meningiomas; OR = 0.056, 95% CI: 0.007-0.428, p = 0.006 for gliomas). However, there was no significant differences in FASL -844 T/C genotype frequencies between patients with primary brain tumors and controls (p > 0.05). In this study, combined genotypes were evaluated for association with primary brain tumors. Combined genotype analysis showed that the frequencies of AATC and AACC were significantly lower in glioma patients in comparison with those of controls (p = 0.023; p = 0.022, respectively). This study provides the first evidence that FAS -1377 AA genotype may have a protective effect on the developing primary brain tumor in a Turkish population.

Surgical management of pseudotumor cerebri syndrome: A single center experience with endoscopic optic nerve decompression and CSF diversion procedures.

OBJECTIVES: Pseudotumor cerebri syndrome (PTC) is a chronic disorder, which is initially treated by conservative measures, yet surgery is inevitable in case of progressive worsening of vision or headache despite medical treatment. The surgical management is controversial including CSF diversion procedures and optic decompression. The purpose of this study was to evaluate the efficacy of different surgeries in PTC and to present surgical outcomes in a single center. METHODS: This retrospective study included the patients with PTC who were operated by endoscopic optic nerve decompression (EOND), ventriculoperitoneal (VP) and lumboperitoneal (LP) shunting. Surgical outcomes, i.e. visual acuity, visual field, papilledema and headache were compared according to type of surgery. Surgical complications were noted. RESULTS: Seventeen of 36 patients were treated with shunting, 14 with EOND and 5 patients with both EOND and shunting. No statistical significance was observed between CSF diversion procedures and EOND concerning clinical outcomes. The improvement rate of papilledema was higher with VPS (p = 0574) while more patients benefitted from LPS regarding visual field and acuity (p = 0471 and p = 0718, respectively). The best treatment response for headache was in shunt implemented patients (VPS and LPS) with a rate of 88.2% followed by EOND (78.6%) and both surgeries (60%)(p = 0.294). Gender and BMI were significant predictors of improved papilledema (p = 0.034). CONCLUSIONS: Our study demonstrated comparable results between shunting and EOND, regarding the efficacy on surgical outcomes. EOND is quite effective for headache besides its advantage on treatment-refractory visual loss. Shunting may offer sustained relief of symptoms when compared with EOND.

Endoscopic treatment of cavum vergae cyst: case report and review.

A 3.5-year-old boy was admitted with febrile convulsion for the first time. The patient had a medical history of in vitro fertilization (IVF) and premature delivery in the 21st week of pregnancy. Further, he suffered from neonatal germinal matrix hemorrhage and intraventricular hematoma (IVH). The patient was treated in the pediatric intensive care unit. Cranial magnetic resonance imaging (MRI) showed resorption of the hematoma with the presence of cavum vergae (CV) variation. The new brain MRI revealed progression of the cavum to a large CV cyst compared with the previous imagings, causing pressure upon both lateral ventricles. Endoscopic fenestration of the lateral walls of the cyst with lateral ventricles was performed. The postoperative period was uneventful and the patient was discharged the next day. Followup MRI one year after surgery showed normal ventricle size, shrinkage of the cyst and cerebrospinal fluid (CSF) flow between the cyst and the lateral ventricles. This is an interesting demonstration of the progression over years of a CV anatomical variation to a large CV cyst in a premature birth case that experienced germinal matrix hemorrhage.

Comparison of two surgical techniques in Chiari Malformation Type 1 Patients: Duraplasty alone vs duraplasty with arachnoid dissection.

OBJECT: Optimal surgical technique to restore the cerebrospinal fluid flow through the foramen magnum remains to be debated in Chiari malformation type 1 (CM-1) patients. METHOD: This study included 46 patients with CM-1 who underwent surgical treatment by one of two methods: posterior fossa bone decompression (BD) with arachnoid preserving duraplasty (Group 1) and BD with duraplasty and arachnoid dissection (Group 2). Complaints of the patient population and neurological findings were assessed with Neck Disability Index (NDI) and Europe Quality of Life 5 Dimensions (EQ-5D) in pre- and postoperative periods. RESULTS: NDI and EQ-5D scores improved in overall patient population and in each individual surgical group. Both groups showed a significant decrease in size of syringomyelia cavity. Complications resulting in recurrent treatments and re-operations occurred in 15% of patients (n = 7); six of them were from Group 2. CONCLUSION: CM-1 patients benefit significantly from surgical treatment. Duraplasty should be included to surgical technique. Avoiding arachnoid dissection may lead to better results regarding complication rates.

Intraoperative Fluorescein Sodium Videoangiography in Intracranial Aneurysm Surgery.

OBJECTIVE: Fluorescein sodium (FNa) videoangiography (VA) was performed to evaluate blood flow within vessels and exclusion of the aneurysm after surgical clipping of intracranial aneurysms. The aim of this study was to report results of FNa-VA in a case series, including benefits and limitations of the technique, and compare intraoperative findings with postoperative cerebral angiography to assess reliability of FNa-VA. METHODS: The study included 64 aneurysms in 50 consecutive patients. Following clip ligation of the aneurysm, 100 mg of FNa was administered intravenously. The microscope light was switched to the FL560 integrated fluorescence module. Aneurysm sac, parent arteries, and perforating arteries were observed. RESULTS: FNa-VA promoted real-time assessment of the surgical field in three-dimensional view through the binoculars with good image quality. In 79.68% of aneurysms, FNa-VA confirmed satisfactory clip application, as FNa did not penetrate into the aneurysm. In 14.06% of aneurysms, a homogeneous yellow-green color change occurred, which was accepted as a false-positive sign. In 6.25% of aneurysms, FNa seeped into the aneurysm emitting a heterogeneous green signal, which slowly dispersed throughout the sac. Postoperative angiography revealed satisfactory results. Small neck remnants were present in 5 patients, and mild parent artery stenosis was found in 3 patients. No ischemic event occurred secondary to parent artery or perforating artery occlusion. CONCLUSIONS: FNa-VA adds greatly to the safety of surgical treatment of intracranial aneurysms, particularly in lesions situated in deep locations, by enabling real-time inspection, which facilitates safer manipulation and evaluation of structures in question.

Endoscopic anatomy of the oculomotor nerve: defining the blind spot during endoscopic skull base surgery.

OBJECTIVE: The objective of this study is to define the endoscopic anatomy of the oculomotor nerve (CN III) and its neurovascular relations in order to facilitate surgical procedures and avoid injury to this nerve during endoscopic endonasal approach to the skull base. MATERIALS AND METHODS: Endoscopic anatomy of the cavernous sinus was studied in seven fresh adult cadavers bilaterally and the basal cisterns in five fresh adult cadavers. Extended endoscopic endonasal suprasellar approach was performed to expose the oculomotor nerve in the interpeduncular cistern and the endoscopic endonasal transethmoidopterygoidosphenoidal approach to expose the oculomotor nerve within the cavernous sinus. RESULTS: The extraorbital part of the oculomotor nerve can be divided into three segments in regard to the cisterns and venous spaces that are being transected: the interpeduncular segment, the cisternal segment, and the intercavernous segment. Of these segments, only the cisternal segment could not be exposed since this segment was located at the initial part of the roof of the cavernous sinus, anterolateral to the posterior clinoid, and posteroinferior to the anterior clinoid processes. Thus, cisternal segment of the oculomotor nerve was considered a blind spot during endoscopic approaches to the skull base. CONCLUSION: We defined the endoscopic anatomy of the CN III and the related neurovascular structures and proposed a new segmental classification of extraorbital oculomotor nerve. Awareness of the endoscopic anatomy and the new segmental classification of the CN III may prove helpful in avoiding the risk of nerve injury during endoscopic endonasal surgery for skull base pathologies.

Endoscopic endonasal anatomy and approaches to the anterior skull base: a neurosurgeon's viewpoint.

OBJECTIVES: The objective of this study was to review the endoscopic anatomy of the anterior skull base, defining the pitfalls of endoscopic endonasal approaches to this region. Recently, these approaches are gaining popularity among neurosurgeons, and the details of the endoscopic anatomy and approaches are highlighted from the neurosurgeons' point of view, correlated with demonstrative cases. MATERIALS AND METHODS: Twelve fresh adult cadavers were studied (n = 12). We used Karl Storz 0 and 30 degrees, 4 mm, 18- and 30-cm rod lens rigid endoscope in our dissections. After preparation of the cadaveric specimens, we approached the anterior skull base by the extended endoscopic endonasal approach. RESULTS: After resection of the superior portion of the nasal septum, bilateral middle and superior turbinates, and bilateral anterior and posterior ethmoidal cells, we could obtain full exposure of the anterior skull base. The distance between optic canal and the posterior ethmoidal artery ranged from 8 to 16 mm (mean, 11.08 mm), and the distance between posterior ethmoidal artery and the anterior ethmoidal artery ranged from 10 to 17 mm (mean, 13 mm). After resecting the anterior skull base bony structure and the dura between the 2 medial orbital walls, we could visualize the olfactory nerves, interhemispheric sulcus, and gyri recti. With dissecting the interhemispheric sulcus, we could expose the first (A1) and second (A2) segments of the anterior cerebral artery, anterior communicating artery, and Heubner arteries. CONCLUSIONS: This study showed that extended endoscopic endonasal approaches are sufficient in providing wide exposure of the bony structures, and the extradural and intradural components of the anterior skull base and the neighboring structures providing more controlled manipulation of pathologic lesions. These approaches need specific skill and learning curve to achieve more minimally invasive interventions and less postoperative complications.

Terminal syringomyelia mimicking an intramedullary tumor: case report.

In this report, the authors present a 14-year-old male patient admitted with progressive paraparesis and urinary incontinence that developed in a 3-month period. Thoracolumbar MRI revealed an intramedullary lesion starting from the level of the T10 vertebra and extending to fill the sacral spinal canal. Based on the radiological findings an intramedullary tumor was suspected. Exploratory operation with right L5 hemilaminectomy was done and the intraoperative finding was syringomyelia which was punctured with releasing of the tethered cord. The patient was followed for 3 years with clinical and radiological regression of the pathology and no symptoms and sings have remained. Syringomyelia can mimic intramedullary tumors clinically and radiologically. That is why it is useful to consider exploratory hemilaminectomy to confirm diagnosis.

Endoscopic management of posterior fossa arachnoid cyst in an adult: case report and technical note.

The authors report a case of large arachnoid cysts of the posterior fossa treated by endoscopic surgery. A 40-year-old man was admitted with a 3-month history of headache and progressive gait imbalance, with no significant medical history. At the time of admission, neurological examination revealed no abnormalities except for tandem imbalance. Brain computerized tomography (CT) scan and magnetic resonance imaging (MRI) revealed a posterior fossa arachnoid cyst (PFAC) causing brain stem compression accompanied by hydrocephalus. The patient was treated by endoscopic fenestration of the cyst with a paramedian suboccipital transcortical approach. Postoperatively the patient's complaints showed improvement and he was discharged with no complications. Follow up MRI showed a decrease in the cyst's size and the hydrocephalus with decompression of the brain stem.

The contribution of SPECT/CT in patients with radionuclide shuntography through shunt dysfunction.

OBJECTIVE: Radionuclide CSF study is a simple, effective, and low-radiation-dose procedure for the assessment of shunt patency. With the help of CT image of single-photon emission computed tomography/computed tomography (SPECT/CT), the interpretation becomes more accurate and easier.The aim of this study was to compare the classical methods and 2D planar scintigraphic images with radionuclide shuntography fused SPECT/CT. METHODS: Between 2015-2019 all hydrocephalic patients who underwent radionuclide shuntography and classical methods (cranial CT, USG and/or direct X-rays), for suspected VP shunt malfunction at our hospital were retrospectively enrolled in the study. Fusion with SPECT/CT is provided in all radionuclide shuntographies. Approximately 0.5-1 mCi diethylene-triaminepentaaceticacid (DTPA) was intrathecally injected. Images were collected as 5-second frames for the first minute, and 1-min frames for the second to the 30th min. Static whole body images were obtained as early (30 min) and delayed (120 min) images. SPECT/CT was performed in 120 min. RESULTS: When the classical methods were evaluated in the operated patients, according to the direct radiographic findings, in only 17 patients had shunt dysfunction due to disconnection-kinking or laceration, was obtained.On the other hand,while67 shuntography were evaluated,65 of these patients (97%) whose intraoperative and shuntography findings were found to be compatible with each other. CONCLUSION: The 3D SPECT images combined with the two-dimensional planar images added to the CT provide more accurate information and also provide detailed anatomical information. The patient's operation was performed successfully in one session in cooperation with the other surgical branches when needed.

Duraplasty using autologous fascia lata reenforced by on-site pedicled muscle flap: technical note.

OBJECTIVE: Postoperative cerebrospinal fluid (CSF) leak is a common complication in the practice of neurosurgery, and various surgical techniques were described to overcome and manage this problem. Besides not applying watertight closure of the duraplasty, the inviability and the poor vascularization of the graft and/or the dura (eg, reoperations, multiple operations, or cranial radiotherapy) may lead to delayed healing of the suture site and resultant persistent CSF leaks. We present a simple technique that uses on-site muscle flap with pedicle to supply and vascularize the autologous fascia lata, preserving the viability of the graft and reenforcing its healing ability. METHODS: We applied this technique in 6 patients with postoperative CSF leaks. After harvesting a fascia lata graft with appropriate size from the patients, the graft was sutured to dural defect in watertight fashion. The suboccipital, temporal, and temporal muscles in 4 patients who had posterior fossa duraplasty, in 1 patient who had pterional craniotomy, and in 1 patient who had subtemporal craniotomy, respectively, were dissected, stretched, and sutured to the fascia graft covering the dura graft suture site and then reinforced by Tisseel fibrin glue (Baxter Healthcare Corporation, Deerfield, IL). Postoperatively, CSF lumbar drain was kept open for 72 hours with pressure wound dressing. The technical nuances are illustrated. RESULTS: Cerebrospinal fluid leaks were controlled successfully in 5 patients without recurrence. One patient with posterior fossa duraplasty had recurrence of CSF leak that required reexploration 21 days after the first surgery and a second dural repair in a site distant from the fascia lata attachment. During reexploration intraoperatively, the fascia lata graft was inspected and studied, which has shown the healing of the dura graft site and the graft neovascularization. CONCLUSIONS: Duraplasty using autologous fascia lata reenforced by on-site pedicled muscle flap is an effective technique to control CSF leak, especially when dura is poorly vascularized and less viable. The unfortunate recurrence of CSF leak and reexploration in the seventh patient helped us to observe the effectively healed dural defect with profound early postoperative vascularization of the graft, supporting our idea about the effectiveness of this technique.

Endoscopic endonasal transsphenoidal approach to the sellar region: results of endoscopic dissection on 30 cadavers.

AIM: To recognize the endoscopic anatomy of the surgical corridor along the nasal cavity, sphenoidal sinus and the sellar area to delineate the pure endoscopic endonasal transsphenoidal approach (EETSA) to the region of the pituitary gland. MATERIAL AND METHODS: The endoscopic anatomy of the nasal cavity, sphenoid sinus and the sellar region was studied in 30 fresh cadavers (mean age 42.1 / range 18-66) and dissections were performed in a stepwise manner to simulate EETSA to the sellar region. RESULTS: The sphenoid ostium, located 14.9 mm superior to the choana, was identified at the midpoint between the nasal septum and the superior turbinate in 23 specimens. The shape of the sphenoid ostium was linear (35%), fusiform (30%), oval(22%) or circular (13%). The mean width of the pituitary gland was 14.3 mm and the average minimum distance between the internal carotid arteries on both sides ranged between 13 to 22 mm. Following total hypophysectomy in 12 specimens, the width and length of diaphragma sellae was measured 10.83 and 5.83 mms respectively. CONCLUSION: This study documents that variations are common in nasal, sphenoidal and sellar phases of the trans-sphenoidal approach. Detailed knowledge of the basic anatomical relationships through the view of the endoscope and performing endoscopic dissections in large number of specimens will facilitate the endoscopic surgical procedures and decrease the rate of surgical complications.

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.

Investigation of Survivin Gene Polymorphism and Serum Survivin Levels in Patients with Brain Tumors.

BACKGROUND/AIM: The single nucleotide polymorphism -31C/G identified in the survivin gene promoter seems to be associated with over-expression of survivin, an anti-apoptotic protein. In gliomas, increased survivin expression correlated with decreased survival. The aim of the study was to investigate whether survivin gene polymorphism associates with benign and malignant brain tumors and whether it affects survivin serum levels. PATIENTS AND METHODS: Survivin polymorphism -31C>G was genotyped in 82 patients with brain tumors and 65 healthy controls by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and survivin levels were evaluated by enzyme-linked immuno sorbent assay (ELISA) in patients and controls. RESULTS: Serum survivin levels in patients with malignant tumors were higher than patients with benign tumors (p<0.001). Survivin levels in patients with malignant glial tumors and the frequency of the GG genotype were higher than in patients with benign tumors (p=0.04) and controls (p=0.05). The prevelance of the survivin gene promoter polymorphism -31C>G did not differ between patients and controls. CONCLUSION: Survivin promoter -31C>G gene polymorphism seems to be associated with serum survivin levels in brain tumors of different grades and histologies.

Prolonged elevation of magnesium in the cerebrospinal fluid of patients with severe head injury.

OBJECTIVES: Several works have investigated the role of serum magnesium (Mg) concentrations in traumatic brain injury. However, there is restricted information about cerebrospinal fluid (CSF) levels of Mg in patients with severe head injury (SHI). We assessed the changes of Mg concentrations in CSF and serum in patients with SHI during the first 10 days after the trauma. METHODS: Eleven patients with SHI were studied prospectively on days 1-3, 5 and 10 with analysis of CSF and serum levels of Mg and Ca. The control group consisted of nine patients with hydrocephalus. RESULTS: CSF levels of Mg were significantly higher in patients than controls in the corresponding time points except on days 5 and 10 of trauma. The CSF Mg levels tended to decrease and the highest level was found on day 1 after trauma (2.81 +/- 0.65 mg/dl). In the control group, the CSF level of Mg was 1.95 +/- 0.66 mg/dl. No significant difference can be detected between controls and patients regarding serum Mg and Ca levels. In addition, significantly higher values of Ca in the CSF were observed in all time points after trauma in patients with SHI than in the controls. There was no correlation between the CSF and serum levels of Mg and Ca levels. DISCUSSION: Our study demonstrates that in patients with SHI, CSF levels of Mg and Ca are elevated during the whole observation period. Further works should be designed in order to show the role and importance of CSF levels of ionized Mg in outcome of patients with SHI.

Cerebral cavernomas and human leukocyte antigens: preliminary clinical results.

BACKGROUND: Although cavernomas are the most common brain vascular malformations, the etiology and risk factor(s) are still not entirely known. Recent publications focusing on the molecular basis suggest that genetic factors may play a role in the development of the brain vascular malformations. We aimed to show HLA typing in brain cavernoma in a group of Turkish patients. METHODS: This study compared HLA types of 30 patients who had brain cavernoma with 30 healthy controls. RESULTS: The analysis of HLA distribution in the patients, compared with healthy control data, revealed some statistically significant differences, even after the more rigid Bonferoni correction (P(c)). In the patients group, the frequency of following HLA antigens was significantly increased compared with the control group: HLA-A1 (P(c): .005), HLA-A24 (P(c): .02), HLA-A32 (P(c): .01), HLA-B51 (P(c): .00001), HLA-DR1 (P(c): .02), and HLA-DR4 (P(c): .004). CONCLUSION: These preliminary data suggest that brain cavernoma susceptibility may be associated with HLA antigens. Further studies should be designed to include a larger population of patients with brain cavernoma in order to expose whether there is association between HLA typing and occurrence of cavernoma more accurately.

High-sensitivity C-reactive protein levels in cerebrospinal fluid and serum in severe head injury: relationship to tumor necrosis factor-alpha and interleukin-6.

Recent studies have demonstrated the role of high-sensitivity C-reactive protein (hsCRP) in inflammatory diseases; however, it is unclear whether this molecule has a role after severe head injury (SHI). Our aim was to evaluate the levels of hsCRP in both cerebrospinal fluid (CSF) and serum from patients after SHI. The study focused on 11 patients with SHI, and evaluated CSF and serum levels of hsCRP, tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) in a 10-day period following the head trauma. The values were compared with those from nine control patients, who had normal pressure hydrocephalus. In the CSF and serum of the patients after SHI, HsCRP was found to be significantly higher, at all times, than in the controls; TNF-alpha and IL-6 levels were also higher in these patients. However, hsCRP levels did not correlate with either TNF-alpha or IL-6. TNF-alpha and IL-6 increased during the period immediately following the SHI, and intrathecal levels were always higher than those of the serum. This study demonstrates for the first time that hsCRP reaches high levels in both CSF and serum in patients with SHI, and it may therefore be used as an inflammatory index. This finding suggests a need for further studies in this area, which are larger in scope than the present study.