Subarachnoid hemorrhage (SAH) triggers intense neuroinflammatory and apoptotic cascades that contribute to secondary brain injury, delayed cerebral ischemia, and poor neurological outcomes. Inflammatory mediators such as interleukin-6 (IL-6) and signal transducer and activator of transcription 3 (STAT3) amplify oxidative stress and endothelial dysfunction, whereas suppression of the hypoxia-inducible factor-1α (HIF-1α)/endothelial nitric oxide synthase (eNOS)/vascular endothelial growth factor (VEGF) pathway impairs hypoxic adaptation and neuronal survival. L-arginine (L-ARG), a nitric oxide precursor, and radiofrequency electromagnetic field (RF-EMF) therapy each exhibit neuroprotective potential through anti-inflammatory and microcirculatory mechanisms. Adult male Wistar rats were assigned to Control, SAH, SAH + L-ARG, SAH + RF, and SAH + L-ARG + RF groups (n = 8 per group). SAH was induced by autologous arterial blood injection into the cisterna magna, followed by daily treatment with L-ARG (500 mg/kg, p.o.) and/or RF-EMF (27.12 MHz, 30 min/day) for seven days. SAH markedly increased NF-κB, TNF-α, Cas-3, IL-6, and STAT3 expression while suppressing HIF-1α, eNOS, and VEGF transcripts. Combined treatment was associated with the most pronounced improvements across measured molecular markers, including reduced inflammation and apoptosis and normalization of mitochondrial regulators (↓BAX, ↑BCL-2). These findings suggest that combined L-ARG and RF-EMF exposure is associated with attenuation of inflammation and apoptosis-related molecular injury after experimental SAH; however, functional and perfusion-based outcomes are required before therapeutic efficacy can be inferred.

MECHANISM-SPECIFIC TIMING OF UNPLANNED REOPERATIONS WITHIN 30 DAYS AFTER SPINAL METASTASIS SURGERY - The Journal of Turkish Spinal Surgery

Delayed decompression for metastatic epidural spinal cord compression (MESCC) is a common real-world problem, yet short-interval recovery after patients have already remained nonambulatory for at least 48 h is poorly defined. We retrospectively evaluated 41 surgically selected patients with MRI-confirmed epidural MESCC (Bilsky grade 2–3) and preoperative nonambulatory neurological deficit (Frankel grades A–C) lasting at least 48 h. The primary outcome was early neurological improvement, defined as a gain of at least one Frankel grade by postoperative days 10–14. The secondary outcome was early ambulation recovery, defined as postoperative Frankel grade D or E at the same interval. Early neurological improvement occurred in 20/41 patients (48.8%), and early ambulation recovery occurred in 15/41 (36.6%). No patient received postoperative index-level radiotherapy before the POD10–14 neurological assessment. Recovery was most common among patients with baseline Frankel grade C. In exploratory adjusted Firth-penalized models, ECOG performance status 3–4 was associated with lower odds of both outcomes. Rapid-growth tumors, classified using a pragmatic adapted growth-category framework, were associated with lower odds of early neurological improvement. Baseline Frankel grade C favored early ambulation recovery. Higher standardized HALP showed an exploratory association with early neurological improvement but did not alter the main clinical interpretation. Meaningful early recovery was observed in a subset of surgically selected MESCC patients despite delayed surgery, although these findings do not establish equivalence to earlier surgery or isolate the effect of surgery from multimodal oncologic care.

POSTOPERATIVE DAY 1 VERSUS DELAYED EARLY MAGNETIC RESONANCE IMAGING AFTER INTRADURAL SPINAL TUMOR SURGERY - The Journal of Turkish Spinal Surgery

Background/Objectives: Children who require surgery after traumatic brain injury (TBI) represent a heterogeneous population. We compared 90-day functional status between epidural hematoma (EDH)-predominant injuries and injuries containing acute subdural hematoma (SDH) and/or cerebral contusion, and examined whether quantitative CT measures added useful context. Methods: We retrospectively studied 53 patients aged 1–18 years who underwent cranial surgery for acute TBI between June 2020 and June 2026. The primary comparison included 41 patients aged ≤ 16 years; 40 (97.6%) had assigned 90-day Glasgow Outcome Scale—Extended Pediatric Revision (GOS-E Peds) status. Preoperative CT scans were reviewed using a predefined protocol. Results: SDH/contusion-associated patients had lower admission GCS (median 10 vs. 15) and higher Rotterdam CT scores (3 vs. 1). Good recovery (GOS-E Peds 1–2) at 90 days occurred in 9/13 (69.2%) SDH/contusion-associated patients and 25/27 (92.6%) EDH-predominant patients. The corresponding exact odds ratio for absence of good recovery was 5.28 (95% CI 0.63–68.02; p = 0.075), with an absolute risk difference of +23.4 percentage points (95% CI −0.8 to 50.8). Adjustment for admission GCS attenuated the association (OR 2.57, 95% CI 0.37–19.09). Continuous midline shift was similar between the CT-pattern groups and was not associated with 90-day status. Conclusions: CT-defined injury patterns identified children with different initial injury burdens, but the 90-day association was imprecise and partly tracked admission neurological severity. CT anatomy should therefore be interpreted together with the clinical examination rather than used as a stand-alone prognostic classifier.