Automatic Segmentation of Vestibular Schwannomas: A Systematic Review.

BACKGROUND: Vestibular schwannomas (VSs) are benign tumors often monitored over time, with measurement techniques for assessing growth rates subject to significant interobserver variability. Automatic segmentation of these tumors could provide a more reliable and efficient for tracking their progression, especially given the irregular shape and growth patterns of VS. METHODS: Various studies and segmentation techniques employing different Convolutional Neural Network architectures and models, such as U-Net and convolutional-attention transformer segmentation, were analyzed. Models were evaluated based on their performance across diverse datasets, and challenges, including domain shift and data sharing, were scrutinized. RESULTS: Automatic segmentation methods offer a promising alternative to conventional measurement techniques, offering potential benefits in precision and efficiency. However, these methods are not without challenges, notably the "domain shift" that occurs when models trained on specific datasets underperform when applied to different datasets. Techniques such as domain adaptation, domain generalization, and data diversity were discussed as potential solutions. CONCLUSIONS: Accurate measurement of VS growth is a complex process, with volumetric analysis currently appearing more reliable than linear measurements. Automatic segmentation, despite its challenges, offers a promising avenue for future investigation. Robust well-generalized models could potentially improve the efficiency of tracking tumor growth, thereby augmenting clinical decision-making. Further work needs to be done to develop more robust models, address the domain shift, and enable secure data sharing for wider applicability.

Beyond human in neurosurgical exams: ChatGPT's success in the Turkish neurosurgical society proficiency board exams.

Chat Generative Pre-Trained Transformer (ChatGPT) is a sophisticated natural language model that employs advanced deep learning techniques and is trained on extensive datasets to produce responses akin to human conversation for user inputs. In this study, ChatGPT's success in the Turkish Neurosurgical Society Proficiency Board Exams (TNSPBE) is compared to the actual candidates who took the exam, along with identifying the types of questions it answered incorrectly, assessing the quality of its responses, and evaluating its performance based on the difficulty level of the questions. Scores of all 260 candidates were recalculated according to the exams they took and included questions in those exams for ranking purposes of this study. The average score of the candidates for a total of 523 questions is 62.02 ± 0.61 compared to ChatGPT, which was 78.77. We have concluded that in addition to ChatGPT's higher response rate, there was also a correlation with the increase in clarity regardless of the difficulty level of the questions with Clarity 1.5, 2.0, 2.5, and 3.0. In the participants, however, there is no such increase in parallel with the increase in clarity.

Cavernous Sinus capillary hemangioma: Case report and literature review.

Introduction: Capillary hemangioma of the cavernous sinus is considered a benign vascular skull base tumor. In this case report, a patient with capillary hemangioma located in the cavernous sinus who was operated on with endoscopic endonasal approach is presented. Research question: What should be considered when planning the treatment for capillary hemangiomas located in the cavernous sinus? Material and methods: The treatment approaches applied in 12 patients with a diagnosis of capillary hemangioma located in the cavernous sinus, reported in the English literature, are reviewed in this article. We presented the clinical and radiological results of the treatments. Results: Cavernous sinus capillary hemangiomas are considered benign tumors. However, surgical treatment is preferred in the foreground because of the neurological deficits due to the compression effect caused by the mass. In the case reported by Masman et al. for the first time in the literature in 2021, they provided total excision with the endoscopic endonasal approach in the patient they first diagnosed by taking a biopsy with the endoscopic endonasal approach. In our case report, we provided total excision with endoscopic endonasal transsphenoidal approach. Discussion and conclusion: Many factors should be considered when deciding on the treatment method in these patients. Although radiotherapy is quite effective in the treatment of capillary hemangioma, surgery should be preferred, especially in symptomatic patients. In patients who cannot undergo surgery, radiotherapy is very valuable, although the long-term results are not yet known.

Clipping of a Rebleeding Ruptured Aneurysm After Woven EndoBridge Treatment.

AIM: To present the clipping of a ruptured aneurysm in the M1 segment of the right middle cerebral artery after rebleeding, which was treated with Woven EndoBridge (WEB). CASE REPORT: A 68-year-old male patient with known hypertension, coronary artery disease and benign prostatic hypertrophy was admitted to our clinic after a ruptured aneurysm of 4.5 mm in the right middle cerebral artery M1 segment and subarachnoid hemorrhage were detected in the emergency room imaging after syncope at home. WEB device was placed into the aneurysm in the patient who was planned for endovascular treatment. After 3 days of the procedure, neurologic examination showed regression. In the brain computed tomography imaging, it was observed that there was an intraparenchymal hematoma of 4,5 cm in the right temporoparietal region and the aneurysm, which had been treated with endovascular WEB, was ruptured. The aneurysm was clipped in the patient for whom emergency surgical treatment was planned. CONCLUSION: As a conclusion, re-bleeding can be seen after aneurysm treatment with the Web device. If it is planned to re-close the aneurysm treated with the web device with a surgical clip, the pressure created by the device against the vessel can be reduced with the additional clip.

Effectiveness of Derivo® Flow Diverter Device in the Endovascular Treatment of Cerebrovascular Aneurysms.

AIM: To report our experience with flow diverter devices in the treatment of intracranial aneurysms, and to share the efficacy and clinical results of the Derivo® flow diverter device in the endovascular treatment of cerebrovascular aneurysms. MATERIAL AND METHODS: This retrospective study was conducted at a regional training and research hospital between October 2015 and March 2020 after approval by the Clinical Research Ethics Committee. The radiology and file records of 21 patients with cerebrovascular aneurysms treated endovascularly using a Derivo® flow diverter device were examined. RESULTS: As per our findings, flow diverter devices were used to treat 27 aneurysms from 21 cases. Among the treated aneurysms, 3, 2, and 22 were in the middle cerebral artery, anterior communicating artery, and internal cerebral artery, respectively. Eight of the patients with a mean age of 56.9 years presented with subarachnoid hemorrhage. Derivo® flow diverters were used alone in 19 cases, whereas concurrent diverter device and coiling were used in only 3 patients. Complete closure of the aneurysms was observed in 3 (14.2%) cases; meanwhile, a 50% reduction in aneurysm size was observed in 2 (9.5%) cases. Complete aneurysm closure occurred in 20 cases (95%) at the 6-month follow-up. Mortality and morbidity each occurred in 1 (4.7%) case. CONCLUSION: Flow diverter devices provide an efficient and safe method of treatment, especially for fusiform, large, giant, widenecked intracranial aneurysms. Endovascular coil embolization treatment is deemed inappropriate for small aneurysms.

How did intraoperative neuromonitorization prevent tetraplegia?

PURPOSE: Patients with mucopolysaccharidosis type IVA (MPS IVA) have many risk factors for myelopathy and paresis. These are spinal cord compression, bone stenosis, and soft tissue thickening with ligament laxity, deformity, odontoid hypoplasia, and atlantoaxial instability. Although most patients with MPS IVA appear generally healthy at birth, patients often show skeletal deformities within a few years. Surgical indications are difficult to determine. Historically, many physicians have used prophylactic decompression and fusion in young, asymptomatic MPS IVA patients to prevent cord compression. Although spinal cord decompression is usually required at the craniocervical junction in patients with MPS IVA, decompression may be required at other spinal cord levels as well. There is a risk of developing neurological damage during surgery. The most common causes are ischemia secondary to cardiac output deteriorated in the prone position or due to artery damage, and local trauma due to neck movements or traction while bringing the patient to the prone position. Neurophysiological monitoring is very important during surgery to reduce the risk of neurological damage in spinal cord surgery. In this case report, a case with loss of lower extremity neuromonitorization motor evoked potential (MEP) responses in the early period of surgery without any intervention to the craniocervical junction after prone positioning will be presented.

The Characterization of Sex Differences in Hypoglycemia-Induced Activation of HPA Axis on the Transcriptomic Level.

Activation of the hypothalamic-pituitary-adrenal (HPA) axis using an insulin tolerance test (ITT) is a medical diagnostic procedure that is frequently used in humans to assess the HPA and growth-hormone (GH) axes. Whether sex differences exist in the response to ITT stress is unknown. Thus, investigations into the analysis of transcripts during activation of the HPA axis in response to hypoglycemia have revealed the underlying influences of sex in signaling pathways that stimulate the HPA axis. We assessed four time points of ITT application in Balb/c mice. After insulin injection, expression levels of 192 microRNAs and 41 mRNAs associated with the HPA, GH and hypothalamic-pituitary-gonadal (HPG) axes were determined by real-time RT-PCR in the hypothalamus, pituitary and adrenal tissues, as well as blood samples (Raw data accession: https://drive.google.com/drive/folders/10qI00NAtjxOepcNKxSJnQbJeBFa6zgHK?usp=sharing ). Although the ITT is commonly used as a gold standard for evaluating the HPA axis, we found completely different responses between males and females with respect to activation of the HPA axis. While activation of several transcripts in the hypothalamus and pituitary was observed after performing the ITT in males within 10 min, females responded via the pituitary and adrenal immediately and durably over 40 min. Additionally, we found that microRNA alterations precede mRNA responses in the HPA axis. Furthermore, robust changes in the levels of several transcripts including Avpr1b and Avpr2 observed at all time points strongly suggest that transcriptional control of these genes occurs mostly via differential signaling in pituitary and blood between males and females. Male and female HPA axis responses to ITT involve a number of sophisticated regulatory signaling pathways of miRNAs and mRNAs. Our results highlight the first robust markers in several layers of HPA, HPG and GH axis involved in ITT/hypoglycemia stress-induced dynamics.

Do We Need Intraoperative Magnetic Resonance Imaging in All Endoscopic Endonasal Pituitary Adenoma Surgery Cases? A Retrospective Study.

There are previous reports investigating effectiveness of intraoperative magnetic resonance imaging (IO-MRI) in pituitary adenoma surgery but there is no clear data in the literature recommending when there is no need of intraoperative scan. This retrospective analysis was based on determining which patients does not need any IO-MRI scan following endoscopic endonasal pituitary adenoma surgery. Patients with functional or non-functional pituitary adenomas that were operated via endoscopic endonasal approach (EEA) between June 2017 and May 2019 were enrolled. Patients younger than 18 years old, patients who did not underwent IO-MRI procedure or not operated via EEA were excluded from the study. Hence, this study is designed to clarify if IO-MRI is useful in both functional and non-functional pituitary adenomas, functional adenomas did not split into subgroups. A total of 200 patients treated with pituitary adenoma were included. In Knosp Grade 0 - 2 group, primary surgeon's opinion and IO-MRI findings were compatible in 150 patients (98.6%). In Knosp Grade 3 - 4 correct prediction were performed in 32 (66.6%) patients. When incorrectly predicted Knosp Grade 3 - 4 patients (n = 16) was analyzed, in 13 patients there were still residual tumor in cavernous sinus and in 3 patients there were no residual tumor. Fisher's exact test showed there is a statistically significant difference of correct prediction between two different Knosp Grade groups (two-tailed P < 0.0001). Eighteen patients had a residual tumor extending to the suprasellar and parasellar regions which second most common site for residual tumor. Our findings demonstrate that there is no need of IO-MRI scan while operating adenomas limited in the sellae and not invading the cavernous sinus. However, we strongly recommend IO-MRI if there is any suprasellar and parasellar extension and/or cavernous sinus invasion.

Altered Global mRNA Expressions of Pain and Aggression Related Genes in the Blood of Children with Autism Spectrum Disorders.

Autism spectrum disorder (ASD) is characterized by repetitive stereotypic behaviors, restricted interests, social withdrawal, and communication deficits. Aggression and insensitivity to pain are largely unexplained in these cases. We analyzed nine mRNA expressions of the candidate genes related to aggression and insensitivity to pain in the peripheral blood of patients with ASD. Whole blood samples were obtained from 40 autistic patients (33 boys, 7 girls) and 50 age- and sex-matched controls (37 boys and 13 girls) to isolate RNA. Gene expression was assessed by quantitative Real-Time PCR (qRT-PCR) in the Erciyes University Genome and Stem Cell Center (GENKOK). All of the gene expressions except CRHR1 and SLC6A4 were found to be statistically different between the ASD patients and controls. Gene expression also differed according to gender. Alterations in the mRNA expression patterns of the HTR1E, OPRL1, OPRM1, TACR1, PRKG1, SCN9A and DRD4 genes provide further evidence for a relevant effect of the respective candidate genes on the pathophysiology of ASD. Future studies may determine the sensitivity of these candidate markers in larger samples including further neuropsychiatric diagnosis.