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OBJECTIVE The objective of this study was to extensively analyze failure patterns of patients who received single or multi-fraction stereotactic radiosurgery (SRS) to the surgical cavity and to identify prognostic factors for recurrence and survival metrics. METHODS Patients with brain metastases who underwent surgical resection and then had SRS to the surgical cavity, between 2010 and 2021, at our department were identified. Local failure (LF), distant failure (DF), leptomeningeal disease (LMD), overall survival (OS), and salvage whole brain radiotherapy (WBRT) rates were calculated. Patient or treatment-related variables were evaluated for association with LF, DF, LMD, and OS. RESULTS Fifty-three patients with total of 54 operated metastases were identified. The median follow-up period was 13 months. Cumulative incidence rates of LF, LMD, and DF were 15%, 11%, and 37% at 1 year, respectively. Salvage WBRT was employed in 13 (26%) patients. DF was less frequent in patients with breast cancer primary compared to patients with other primaries (p=0.048, Hazard ratio [HR]:0.28) on univariate analysis. One-year OS rate was 54%. Median survival was 17 months. Eastern cooperative oncology group (ECOG) 0 performance status (p=0.0113; HR:0.328), being without active extracranial metastasis at the time of brain SRS (p=0.0035; HR:0.321), and metachronous brain metastases (p=0.0191; HR:0.399) were determined as statistically significant prognostic factors of survival on multivariate analysis. CONCLUSION SRS to surgical cavity seems optimal treatment modality especially for the patients with one of the following factors including ECOG 0 performance status, not having an active extracranial metastasis at the time of SRS, and metachronous brain metastases. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the value of T1-weighted (T1W)/FLAIR (fluid attenuation inversion recovery) imaging in routine brain magnetic resonance (MR) evaluation by comparing the T1W spin-echo (SE) sequence with the T1W rapid FLAIR sequence in terms of identifiability of anatomical structures and image quality. Methods: T1W SE and T1W rapid FLAIR sequences were qualitatively and quantitatively analysed with regard to the identification of anatomical structures, general image quality and presence of artefacts in 30 healthy cases. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) values were determined using the signal intensity values of two sequences from equivalent localisations, including the grey substance, white substance and cerebrospinal fluid at the level of the posterior fossa and thalamus. Results: SNR values were significantly higher in T1W SE than in T1W FLAIR sequences at the level of the thalamus and posterior fossa (p<0.001). Measurements at the thalamic level revealed that CNR values of T1W FLAIR for cerebrospinal fluid-grey substance and grey-white substance were significantly higher when compared to T1W SE (p=0.0001). The measurements at the posterior fossa level demonstrated that CNR values of T1W FLAIR for grey-white substance were significantly higher when compared to T1W SE (p=0.006). Conclusion: In this study, we found that in T1W imaging of the brain, T1W FLAIR sequence was superior to T1W SE in qualitative and quantitative evaluations in terms of CNR values. Nevertheless, SNR values were found to be higher in T1W SE imaging. [ABSTRACT FROM AUTHOR]

Objective: The literature points to the role of neuroinflammation in the aetiology of vasospasm, which is the leading cause of mortality and morbidity after aneurysmal subarachnoid haemorrhage. Neuroinflammation has been found to contribute to early and delayed brain injury, both of which are associated with poor clinical outcomes. Resolvin D1 is hypothesised to have a protective effect on neurons against apoptosis and has anti-inflammatory and pro-resolving effects on the neuroinflammation and vasospasm after aneurysmal subarachnoid haemorrhage. In this study, we aimed to investigate the serum resolvin D1 levels and its possible relationship with vasospasm and inflammatory markers, such as C-reactive protein, neutrophil and albumin in patients with aneurysmal subarachnoid haemorrhage. Methods: Fifteen patients with spontaneous aneurysmal subarachnoid haemorrhage between June 2017 and May 2018 presenting at our institution were included in the study. Their data were compared with those of 17 healthy volunteers. Patients with aneurysmal subarachnoid haemorrhage were divided into two groups: the subarachnoid haemorrhage with vasospasm group (8 patients), which included patients with subarachnoid haemorrhage and angiographic vasospasm, and subarachnoid haemorrhage without vasospasm group (7 patients), which included patients with subarachnoid haemorrhage without angiographic vasospasm. Serial serum resolvin D1 measurements were taken on days 1, 4, 9 and 14 after subarachnoid haemorrhage. Results: Resolvin D1 levels were statistically significantly higher on day 1 after subarachnoid haemorrhage in patients with angiographic vasospasm (p=0.021). Additionally, in the group with angiographic vasospasm, all the measured resolvin D1 values were also higher compared to other groups. The measurements of serum C-reactive protein and neutrophil levels were found to be statistically significantly higher on day 1 after subarachnoid haemorrhage in both groups compared to the control group. Conclusion: Resolvin D1 levels tend to increase secondary to inflammation because of its neuroprotective and anti-inflammatory properties. Thus, high resolvin D1levels in the subarachnoid haemorrhage + vasospasm group indicated that inflammatory processes play a role in the aetiopathogenesis of angiographic vasospasm after aneurysmal subarachnoid haemorrhage. Consequently, resolvin D1 might be an important biomarker in the prediction of the angiographic vasospasm after aneurysmal subarachnoid haemorrhage. [ABSTRACT FROM AUTHOR]

Human falx cerebelli is an important anatomical structure in regard to its relations with venous structures during infratentorial approach to reach cerebellar tumors, vascular malformations, traumatic hemorrhage and Chiari malformations. The present study aim to describe the different types of variations of the falx cerebelli, its morphological features and its association with occipital venous sinuses. In this study 49 dura mater was obtained from the Institution of Forensic Medicine. The length, width and the depth of the falx cerebelli were measured using a digital compass. The data obtained were statistically analyzed in relation to age and gender. The relations of the falx cerebelli with the occipital sinus was documented. Histological sections from the falx cerebelli were stained with Hematoxylin Eosin to evaluate the fine structure. Among the 49 falx cerebelli examined 36 (73.5%) were classified as normal. The average length, width and depth of the normal falx cerebelli was 3.7, 1.0 and 0.4 cm respectively. Of the 49 falx cerebelli in 1 (2%) case it was absent, in 5 cases (10.2%) duplicate, in 5 cases (10.2%) triplicate, in 1 (2%) case quadruplets and in 1 case (2%) it was five-folded. The proximal and the distal attachments of the falx cerebelli showed 3 types of variations; both attachments triangular, the proximal attachments triangular and the distal ramified and distal attachments triangular and the proximal attachments ramified. The drainage of the occipital sinus of falx cerebelli with variations were evaluated. The increased number of falx cerebelli highly corresponded with the increased number of occipital sinus. The dural-venous variation in the posterior cranial fossa can be problematic in various diagnostic and operative procedures of this region. Neurosurgeons should be aware of such variations, as these could be potential sources of haemorrhage during the midline suboccipital and infratentorial approaches. [ABSTRACT FROM AUTHOR]

Objective: This study is an examination of the protective effects of alpha-lipoic acid (ALA) on cerebral vasospasm in an experimental rat model with subarachnoid hemorrhage (SAH) using biochemical, pathological, and histomorphometric analyses. Methods: A total of 28 albino Wistar rats were randomly categorized into 4 groups (n=7 each): Group (G)1, no experimental intervention; G2, subjected to SAH; G3, subjected to SAH and given physiological saline (100 mg/kg); and G4, subjected to SAH and treated with ALA (100 mg/kg). Results: No statistically significant decrease in malondialdehyde level, the end product of lipid peroxidation, was observed among the drug groups (G3 and G4). Furthermore, there was no statistical increase in paraoxonase level, an endogenous antioxidant enzyme, among the drug groups (G3 and G4). Thin sections of the basilar artery were morphologically examined, and severe luminal narrowing and vessel wall thickening were observed in the SAH groups (G2 and G3). In the ALA group (G4), vessel wall thickness measurements revealed no statistically significant difference compared with the other SAH groups (G2 and G3); however, G4 rats were found to have larger luminal diameters than those in G3. Conclusion: These findings suggest that ALA had no effect on malondialdehyde-associated lipid peroxidation and paraoxonase activity; however, it had a favorable effect on basilar artery luminal diameter in the treatment of cerebral vasospasm following SAH. [ABSTRACT FROM AUTHOR]