The association between calreticulin and glucagon-like peptide-1 expressions with prognostic factors in high-grade gliomas.

OBJECTIVE: The aim of this study is to present the expressions of Calreticulin (CALR) and Glucagon-like peptide-1 (GLP-1) in high-grade gliomas and to further show the relation between the levels of these molecules and Ki-67 index, presence of Isocitrate dehydrogenase (IDH)-1 mutation, and tumor grade. PATIENTS AND METHODS: A total of 43 patients who underwent surgical resection due to high-grade gliomas (HGG) (grades III and IV) were included. The control group comprised 27 people who showed no gross pathology in the brain during the autopsy procedures. Adequately sized tumor samples were removed from each patient during surgery, and cerebral tissues were removed from the control subjects during the autopsy procedures. Each sample was stored at -80°C as rapidly as possible until the enzyme assay. RESULTS: Patients with high-grade gliomas showed significantly higher levels of CALR and significantly lower levels of GLP-1 when compared to control subjects (P = 0.001). CALR levels were significantly higher, GLP-1 levels were significantly lower in grade IV gliomas than those in grade III gliomas (P = 0.001). Gliomas with negative IDH-1 mutations had significantly higher CALR expressions and gliomas with positive IDH-1 mutations showed significantly higher GLP-1 expressions (P = 0.01). A positive correlation between Ki-67 and CALR and a negative correlation between Ki-67 and GLP-1 expressions were observed in grade IV gliomas (P = 0.001). CONCLUSIONS: Our results showed that higher CALR and lower GLP-1 expressions are found in HGGs compared to normal cerebral tissues.

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.

Multilevel Cervical Epidural Hematoma After C5-6 Anterior Cervical Discectomy and Fusion: The Cry of a Neurosurgeon.

Anterior cervical discectomy and fusion (ACDF) is a safe and effective surgical treatment for cervical degenerative disk diseases. Almost every neurosurgeon is familiar with this approach. Anterior multilevel epidural hematoma (EDH) after a single ACDF is a very rare complication documented in the literature. There is no common consensus on the choice of optimal surgical treatment. Here, we report the case of a patient who showed multilevel EDH after ACDF at the C5-6 level to highlight that this complication should be kept in mind even after an uneventful surgery.

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 Outcome of Young and Adult Patients with Temporal Lobe Epilepsy Related to Hippocampal Sclerosis in Modern Era.

AIM: To evaluate the preoperative, operative, and postoperative outcomes of young and adult patients who underwent surgery for temporal lobe epilepsy related to hippocampal sclerosis (TLE-HS). MATERIAL AND METHODS: This retrospective study assessed prospectively registered data collected from 2010 to 2020. Clinical, electrophysiological, pathological, and postoperative outcomes were evaluated and compared. Post-surgical seizure outcome was classified into continuous seizure freeness without aura and relapse. RESULTS: In total, 16 young and 48 adult patients with TLE-HS were included in the analysis. The clinical, electrophysiological, pathological, and postoperative outcomes were similar between the young and adult groups. However, the seizure outcome did not significantly differ between the two groups (p=0.38). A significant proportion of patients in both groups were satisfied with the surgical outcomes. CONCLUSION: Surgery is extremely effective against TLE-HS in young patients, as in adults. Furthermore, the clinical, radiological, and pathological outcomes are similar between young and adult patients with TLE-HS.

A clinical evaluation of gelastic and dacrystic seizures: a multicenter study.

BACKGROUND: Gelastic seizures are extremely rare, short-lasting, unprovoked, and uncontrollable laughing attacks. We conducted this retrospective evaluation to determine whether these symptoms, manifesting in different forms, such as cheerful laughter, laughing, smiling, and sobbing had any value in terms of etiology or localization. METHODS: A total of 31 patients who exhibited bouts of laughing or crying and who were under follow-up between 2000 and 2019 at tertiary epilepsy centers were included in the study. Laughing seizures were divided into three groups in terms of semiology (i.e., laughter with mirth, laughter without mirth, and smile). Dacrystic seizures were accompanied by some gelastic seizures and were divided into two groups in terms of semiology (i.e., weeping loudly [motor and voice-sobbing] and crying). RESULTS: Of the 27 patients with laughing seizures, 12 had seizures that manifested with smiling, 7 had seizures that manifested with laughing and mirth, and 8 had seizures that manifested with laughter without mirth. Dacrystic-gelastic seizures were observed in four patients, among whom 2 patients had crying and laughter without mirth and 2 patients had weeping loudly and laughter without mirth episodes. CONCLUSION: Gelastic and dacrystic seizures often suggest hypothalamic hamartomas, in the literature. This rare ictal behavior can originate from different cortical locations and lesions of a different nature. However, we found that gelastic seizures with smiling were a more homogenous group with regard to location in the temporal lobe, which we aimed to show by evaluating the patients included in this study.

ANTECEDENTES: Crises gelásticas são ataques de riso extremamente raros, de curta duração, não provocados e incontroláveis. Realizamos esta avaliação retrospectiva para determinar se esses sintomas, manifestando-se de diferentes formas, como riso alegre, riso, sorriso e soluço, tinham algum valor em termos de etiologia ou localização. MéTODOS: Foram incluídos no estudo 31 pacientes que apresentavam crises de riso ou choro e que estavam em acompanhamento entre 2000 e 2019 em centros terciários de epilepsia. As crises de riso foram divididas em três grupos em termos de semiologia (ou seja, riso com alegria, riso sem alegria e sorriso). As crises dacrísticas foram acompanhadas por algumas crises gelásticas e foram divididas em dois grupos em termos de semiologia (ou seja, choro alto [motor e soluçar a voz] e choro). RESULTADOS: Dos 27 pacientes com crises de riso, 12 tiveram crises que se manifestaram com sorriso, 7 tiveram crises que se manifestaram com riso e alegria e 8 tiveram crises que se manifestaram com riso sem alegria. Crises dácristico-gelásticas foram observadas em quatro pacientes, sendo 2 pacientes com choro e riso sem alegria e 2 pacientes com choro alto e riso sem alegria. CONCLUSãO: Crises gelásticas e dacrísticas frequentemente sugerem hamartomas hipotalâmicos, na literatura. Este comportamento ictal raro pode ter origem em diferentes localizações corticais e lesões de natureza diversa. No entanto, verificamos que as crises gelásticas com sorriso foram um grupo mais homogêneo quanto à localização no lobo temporal, o que buscamos evidenciar avaliando os pacientes incluídos neste estudo.

Do we need postoperative antibiotics in supratentorial clean neurosurgery? A prospective, randomized, single-blind, and placebo-controlled study.

BACKGROUND: To assess the efficacy of postoperative antibiotics on postoperative infection in clean supratentorial craniotomies. METHODS: This study is a prospective, randomized, single-blind, and placebo-controlled clinical trial that included consecutive patients who underwent clean supratentorial craniotomy between November 2017 and September 2020 and evaluated the effectiveness of postoperative antibiotic prophylaxis on postoperative infection. RESULTS: A total of 80 patients were included and the whole group was divided into two groups. Group A included patients who received antibiotic prophylaxis and group B who did not receive antibiotic prophylaxis after surgery. Each group included the same number of patients (40 patients in each). Two patients showed postoperative infection, and both were in group B. No significant difference was found regarding postoperative infection between the two groups (p = 0.15). The rate of postoperative infection was found to be 2.5% in the whole group (2 cases out of 80) and it was 5% in group B (2 cases out of 40). DISCUSSION: Our results showed that antibiotic prophylaxis after a clean supratentorial craniotomy has no effect on the prevention of postoperative infection and we do not suggest using antibiotic prophylaxis after clean supratentorial neurosurgery.

Trigeminal neuralgia as a complication after anterior temporal lobectomy: A case report.

Temporal lobe epilepsy (TLE) is one of the most common forms of focal epilepsy. Anterior temporal lobectomy (ATL) leading to high rate of seizure freedom is a safe and well-established procedure in TLEs. Cranial nerve deficits, especially for oculomotor, trochlear and facial nerve were reported as a complication after ATL. Nonetheless, trigeminal neuralgia due to ATL is a very rare complication documented in the literature. The surgeons performing ATL procedures must be aware of the risk of trigeminal nerve injury, avoid excessive electrocautery use in the medial part of middle fossa and provide clean surgery in there to prevent this rare complication.

Seizure Outcome in Adult Patients with Supratentorial Cavernomas.

Background Cavernomas are usually found in the supratentorial area, and epileptic seizures are one of the presenting symptoms. Objective This study aims to provide the seizure outcome in adult patients who underwent surgical excision of single supratentorial cavernomas. Materials and Methods A total of 23 patients with single supratentorial cavernomas were operated between May 2011 and January 2019. Pre- and postoperative seizure semiology, clinical, and radiological findings were collected from medical records. At the last follow-up, each patient was seen during regular visits and clinical variables were noted. Results The mean age was 37.08 ± 10.5 years, and 11 (57.8%) and 12 (52.2%) were females and males, respectively. Headache (43.5%) and seizure (43.5%) were the most common presenting symptoms. Cavernomas were located on the right side in 13 and on the left side in 10 patients. The most common locations were the frontal (43.5%) and temporal (43.5%) lobes. The mean follow-up in this series was 41.4 ± 30.8 months. Our results showed that surgery was effective in seizure outcome, as almost 70% of patients who had seizure before surgery was seizure free after surgery, and the difference between those who had seizure pre- and postoperative periods was statistically significant ( p = 0.0001). Conclusion Surgery is safe and effective for supratentorial cavernomas. The excision of cavernoma together with the surrounding hemosiderin should be performed to obtain a satisfactory seizure outcome.

Secondary Parkinsonism in a Patient With a Cerebral Cavernous Hemangioma Treated With Stereotactic Radiosurgery.

Secondary parkinsonism is defined with some symptoms similar to idiopathic Parkinson's disease, but with different etiologies. And cerebral cavernous hemangioma is one of the rare cases. A 51-year-old, male patient was consulted with tremor, rigidity and bradykinesia on the right upper extremity. The Hoehn and Yahr Parkinson's scale was Stage І. Radiological evaluations showed a deep-seated cerebral cavernous hemangioma at the left posterior insular region. The patient received stereotactic radiosurgery (CyberKnife®, Accuray Incorporated, Sunnyvale, CA, USA). Clinical and radiological improvements revealed within follow-up, respectively. Stereotactic radiosurgery may be an alternative treatment for secondary parkinsonism by reducing the risk of re-bleeding and reducing its size.

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.

Circulating Levels of Thrombospondin-1 and Thrombospondin-2 in Patients with Temporal Lobe Epilepsy Before and After Surgery.

AIM: To measure the serum levels of strong angiostatic and synaptogenetic molecules thrombospondin-1 (TSP-1) and thrombospondin-2 (TSP-2) in patients with temporal lobe epilepsy (TLE) before and after surgery. MATERIAL AND METHODS: In this prospective study, 20 patients operated for TLE and 20 healthy subjects were included. Serum levels of TSP-1 and TSP-2 were measured using enzyme-linked immunosorbent assay (ELISA). RESULTS: Our findings showed that both groups had higher serum levels of both molecules "before" surgery than 10 days ?after? SURGERY: However, a significant difference was noted between ?before? and "after" surgery regarding TSP-1 (p=0.00001). Although a marked decrease was found "after" surgery with respect to TSP-2, the difference did not reach statistical significance (p=0.22). In patients with TLE, serum levels of both molecules ?before? surgery were found to be significantly higher than in healthy controls (TSP-1, p=0.00001; TSP-2, p=0.007). CONCLUSION: Serum levels of TSP-1 and TSP-2 are determined to be higher in patients with TLE than in healthy subjects, and the resection of epileptogenic tissues decreases the serum levels of these molecules. Future studies should involve a higher number of patients with serial serum levels of TSP-1 and TSP-2 at the long-term follow-up to correlate with seizure outcome.

Evaluation of patients with late-onset and medically refractory temporal lobe epilepsy with mesial temporal sclerosis.

OBJECTIVES: Our study aims to compare demographics, clinical features and postsurgical outcomes between early and late-onset patients with medically refractory temporal lobe epilepsy (TLE) related to mesial temporal sclerosis (MTS). PATIENTS AND METHODS: Seventy-one patients admitting to the Epilepsy Clinic of Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine between 1995-2015, who were diagnosed with refractory TLE related to MTS, were included in our study. All of these patients were resistant to medical treatment, and thus candidates for, or underwent surgery, and had no pathology other than MTS in their cranial magnetic resonance imaging (MRI). Based on previous studies, those patients were divided into two categories as "early-onset" and "late-onset", according to the age-onset of afebrile recurrent seizures, where the cutoff was determined as 20 years. Demographics, clinical features, and postsurgical outcomes were compared between both groups. RESULTS: Fifty-three patients included in our study had early-onset MTS-TLE, and 18 patients had late-onset MTS-TLE. Demographics, clinical features, characteristics of electroencephalography (EEG), MRI, PET MRI/CT, neuropsychometric test (NPT) and postsurgical outcomes were similar in both groups. CONCLUSION: In both the early-onset and late-onset groups, the presence of similar demographics, clinical features, and postoperative outcomes have suggested that the course of the disease and the success of surgical treatment were not associated with the age-onset of seizures in TLE related to MTS.

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.

Can preoperative neutrophil to lymphocyte, lymphocyte to monocyte, or platelet to lymphocyte ratios differentiate glioblastoma from brain metastasis?

This retrospective analysis of patients aims to show the blood levels of preoperative inflammatory markers in patients with glioblastoma and brain metastasis and to provide the diagnostic accuracy of the neutrophil-lymphocyte (NLR), lymphocyte-monocyte (LMR), and platelet-lymphocyte (PLR) ratios between the 2 groups of patients.The retrospective reviews of the neutrophil, lymphocyte, monocyte, and platelet counts were analyzed in 80 patients with newly diagnosed glioblastoma and 70 patients with brain metastasis. The NLR, LMR, and PLR were calculated in each group. The differences in all the parameters were compared between the 2 groups.Although the neutrophil, monocyte, and platelet counts were higher and the lymphocyte count was lower in patients with metastasis, the difference was not significant. A significantly higher PLR (P = .004) and a lower LMR (P = .01) were found in patients with brain metastasis. Although both PLR and LMR had diagnostic accuracy in differentiating glioblastoma from brain metastasis, LMR showed the highest diagnostic accuracy. NLR showed no diagnostic accuracy.Systemic inflammation is more severe in glioblastoma than in brain metastasis, and LMR is more sensitive and/or specific than PLR in differentiating glioblastoma from brain metastasis. Therefore, LMR (less likely PLR) can be used as an index for differentiating between glioblastoma and brain metastasis before surgery.

Are low-grade gliomas of mesial temporal area alone?

BACKGROUND: Temporal neocortex which appears normal on magnetic resonance imaging (MRI) may have pathological tissues in low-grade gliomas (LGG) of pure mesial temporal area. Resection of the cortex may be required together with mesial temporal glioma for satisfactory seizure and oncological outcome. The aim of this study was to explore the presence of any pathological tissue on the temporal cortex that appeared normal on preoperative MRI in patients with pure mesial temporal LGGs. METHODS: This prospective study included 10 patients who underwent surgical resection of temporal lobe for LGG of mesial temporal area. The temporal neocortex with normal appearance on MRI and mesial temporal area were resected separately, and histopathological diagnosis was performed. RESULTS: LGGs of the mesial temporal area were diagnosed with glioneuronal tumors in 7 (70%) and low-grade astrocytoma in 2 (20%) patients. Regarding the temporal cortex, gliosis and focal cortical dysplasia were found in 7 (70%) and 2 (20%) patients. In one patient temporal cortex did not contain any pathological tissue. All were seizure-free and no tumor recurrence was noted at the last follow-up. CONCLUSION: Mesial temporal LGGs are not alone and a high proportion of temporal neocortex appeared normal on preoperative MRI, may contain dual pathology. Thus, anterior temporal resection should be performed to have satisfactory seizure and oncological outcomes.

Preoperative systemic inflammatory markers in low- and high-grade gliomas: A retrospective analysis of 171 patients.

PURPOSE: Preoperative neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) are recognized as prognostic markers of grade of gliomas. The aim of this study was to determine whether preoperative levels of NLR, PLR, and LMR differ between low- and high-grade gliomas. METHODS: Retrospective analysis of preoperative neutrophil, lymphocyte, monocyte, and platelet counts and NLR, PLR, and LMR were performed in 171 patients who underwent glioma surgery. The results were compared between low- and high-grade gliomas. RESULTS: Neutrophil count was significantly increased while lymphocyte count significantly decreased in high-grade gliomas (HGGs). NLR and PLR were significantly higher in HGGs but LMR was significantly reduced in HGGs. NLR and PLR correlated with glioma grade and only NLR showed highest accuracy predicting higher grade. CONCLUSIONS: Levels of preoperative NLR value can help to evaluate disease progression and predict higher grade of glioma.

What happens to temporal hypometabolism contralateral to side of surgery in patients with bilateral temporal hypometabolism?

OBJECTIVE: To see what happens on PET hypometabolism on the temporal lobe contralateral to the side of surgery in patients with bitemporal hypometabolism (BTH). PATIENTS AND METHODS: This retrospective study with prospectively defined data evaluated the pre- and post-surgical PET hypometabolism on the contralateral temporal lobe after resection of ipsilateral temporal lobe in 10 patients with BTH operated between January, 2010 and May, 2018. On PET we compared standard uptake values (SUV) and relative metabolic activities as compared to normal subjects by means of Z-scores of hypometabolism of unresected temporal lobes before and after surgery. RESULTS: Surgery did not lead to satisfactory seizure outcome and only 3 patients were seizure free. All but one were still using anti-epileptic drug. No significant change was noted on PET hypometabolism related to the contralateral temporal lobe at the last follow-up. Regarding the mean SUV, comparisons showed that the difference with respect to the mesial structures was significant (p = 0.04). But lateral cortex showed insignificant difference (p = 0.21) before and after surgery. Regarding the mean Z-score, no significant differences were found between both the mesial temporal structures (p = 0.23) and lateral temporal cortex (p = 0.18). CONCLUSION: Surgery does not lead to improvements on PET hypometabolism of the temporal lobe contralateral to the side of surgery and hypometabolism on the contralateral side may be due to structural damage rather than functional deficits secondary to propagation of repetitive seizures. Seizure outcome is not satisfactory and before surgery patients or their next of kin should be informed in detail.

Preoperative Systemic Inflammatory Markers in Different Brain Pathologies: An Analysis of 140 Patients.

AIM: To analyze preoperative inflammatory markers including neutrophil, lymphocyte and platelet counts and neutrophil to lymphocyte (NLR) and platelet to lymphocyte (PLR) ratios in a group of patients with different brain pathologies and healthy controls. MATERIAL AND METHODS: Above mentioned preoperative inflammatory markers were analyzed in a total of 140 patients included 39 with temporal lobe epilepsy, 37 with glioblastoma multiforme, 32 with grade-I meningioma and 32 with intracranial metastasis. Healthy controls included 30 subjects. The levels were compared between each patient group and between patients and controls. RESULTS: Significant higher neutrophil, platelet counts, NLR and PLR were found in glioma, meningioma and metastasis patients compared to epilepsy (p < 0.05). On the other hand lymphocyte counts were significantly lower than epilepsy (p < 0.05). PLR > 120.78 was suggestive of metastasis rather than GBM. CONCLUSION: Preoperative inflammatory markers increase in different brain pathologies and metastasis show striking changes. PLR can have diagnostic value in differentiating metastasis from GBM.