Introduction Ventriculoperitoneal shunt complications, particularly infection and mechanical dysfunction, represent major causes of morbidity and revision surgery in patients with hydrocephalus. Objective This study aimed to evaluate our single-center experience with ventriculoperitoneal shunt revisions and to compare shunt infection and mechanical shunt dysfunction in order to identify institution-specific clinical, laboratory, and cerebrospinal fluid (CSF) characteristics that may facilitate differential diagnosis. Results Among the patients, 140 (35.9%) were diagnosed with ventriculoperitoneal shunt infection, while 250 (64.1%) had mechanical shunt dysfunction. Fever, elevated C-reactive protein (CRP) and white blood cell (WBC) levels, reduced CSF glucose, and increased CSF protein levels were significantly more frequent in the infection group (p<0.001). Shunt infections predominantly occurred in the early postoperative period, whereas mechanical shunt dysfunction was more commonly observed during the late postoperative period. Coagulase-negative staphylococci were the most frequently isolated pathogens in CSF cultures. Conclusion Ventriculoperitoneal shunt infection and mechanical shunt dysfunction demonstrate clearly distinct clinical and biochemical profiles. Early assessment of these parameters may facilitate more accurate differentiation and support rational clinical decision-making.

Kronik Subdural Hematom: Tanı ve Tedavi Yasin TAŞKIN Travmatik İntraserebral Hematom Tolga EROL Akut Subdural Hematom İsmail İÇLEK Travmatik Hemorajik Kontuzyon Hasan ŞENER Recai ENGİN Epidural Hematom Veysel KIYAK Travmatik Subaraknoid Kanama Durmuş Emre KARATOPRAK

Background and Objectives: The optimal surgical technique for Chiari type I malformation (CM-I) remains debated, particularly in patients without syringomyelia. While duraplasty (DP+) may enhance radiological outcomes, it can carry higher complication risks. We compared clinical, radiological, and morphometric outcomes after suboccipital decompression with DP+ and without duraplasty (DP−), with prespecified subgroup analyses by syringomyelia status. Materials and Methods: Ninety-three consecutive adult CM-I underwent DP− (n = 54) or DP+ (n = 39) between 2014 and 2022. Pre- and post-operative MRI and neurological evaluations were obtained at 1 year. Functional recovery was assessed using the Chicago Chiari Outcome Scale (CCOS). Clinical and radiological outcomes, complication rates, and subgroup results (with vs. without syringomyelia) were compared. Results: Overall clinical improvement was observed in 92.5% of patients (DP−: 94.4%; DP+: 89.7%; p > 0.05). Among patients without syringomyelia, clinical improvement remained high with DP−. Radiological benefit—including syrinx regression and mega cisterna magna formation—was greater with DP+ (64.1% vs. 24.1%; p < 0.001), but this did not translate into improved functional outcomes (p > 0.05). Cerebellar slump occurred more often after DP+ (30.8% vs. 9.3%; p < 0.05). Complication rates, particularly CSF-related events, were significantly higher with DP+ (17.9% vs. 3.7%, p = 0.032). Morphometric expansion of the foramen magnum did not correlate with functional outcomes. Conclusions: At 1-year follow-up, suboccipital decompression without duraplasty appears to provide comparable clinical improvement to DP+, with fewer complications, in selected CM-I patients without syringomyelia. Duraplasty offers radiological advantages, especially for syringomyelia, but at the cost of increased risk. Longer follow-up is necessary to determine the durability of these findings.

Background: Although numerous magnetic resonance imaging (MRI) findings have been described in idiopathic intracranial hypertension (IIH), the potential contribution of craniocervical junction morphology to disease pathophysiology and diagnosis remains largely unexplored. This study aimed to evaluate foramen magnum morphology and cerebrospinal fluid (CSF) spaces at the craniocervical junction in patients with IIH and to investigate their associations with disease severity and diagnostic performance. Methods: In this retrospective case–control study, 70 patients diagnosed with IIH according to the modified Dandy criteria and 70 age- and sex-matched controls were included. Brain MRI examinations were retrospectively reviewed. Optic nerve sheath diameter, optic nerve tortuosity angle, foramen magnum anteroposterior and transverse diameters, foramen magnum area, foramen magnum index, and anterior and posterior subarachnoid CSF spaces were measured. Correlation analyses with lumbar puncture opening pressure and papilledema grade were performed. Independent imaging predictors of IIH were identified using multivariable logistic regression analysis, and diagnostic performance was assessed using receiver operating characteristic (ROC) analysis. Results: Compared with controls, patients with IIH demonstrated significant alterations in craniocervical junction morphology, including smaller foramen magnum anteroposterior diameter, foramen magnum area, foramen magnum index, and anterior subarachnoid CSF space, together with increased optic nerve sheath diameter and reduced optic nerve tortuosity angle (all p < 0.001). Foramen magnum morphometric parameters and anterior subarachnoid CSF space were significantly associated with both lumbar puncture opening pressure and papilledema grade. Multivariable logistic regression identified optic nerve sheath diameter (OR = 2.143, p = 0.002), optic nerve tortuosity angle (OR = 0.925, p < 0.001), and foramen magnum index (OR = 0.526 per 0.1-unit increase, p = 0.001) as independent imaging predictors of IIH. The combined prediction model demonstrated excellent diagnostic performance (AUC = 0.901), with 81.4% sensitivity and 87.1% specificity. Conclusions: Craniocervical junction morphometric features and subarachnoid CSF spaces at the foramen magnum differed between patients with IIH and controls and may provide complementary imaging information. These cross-sectional associations do not establish whether the observed differences are pre-existing anatomical characteristics or secondary changes related to chronically elevated intracranial pressure. Prospective multicenter studies incorporating dynamic CSF-flow imaging are warranted to validate these findings and clarify the temporal relationship between these morphometric features and disease development.

Giriş: Derin yerleşimli intrakraniyal lezyonlarda stereotaktik biyopsi, cerrahi olarak ulaşılamayan ya da yüksek riskli bölgelerde tanı koymak için tercih edilen, minimal invaziv bir yöntemdir. Bu çalışmada, 2012–2024 yılları arasında uygulanan stereotaktik biyopsilerin tanısal doğruluğu, güvenliği ve klinik sonuçları değerlendirildi. Yöntem: Ondokuz Mayıs Üniversitesi’nde, 2012-2024 yılları arasında stereotaktik biyopsi uygulanan 70 hasta retrospektif olarak incelendi. Dışlama kriterlerine uyan 59 hastanın demografik özellikleri, başvuru semptomları, lezyon lokalizasyonu, patolojik tanıları ve yatış süreleri analiz edildi. Bulgular: Hastaların yaş ortalaması 53,8 yıl olup, lezyonlar en sık talamus (%35,6) ve bazal gangliyon (%22) bölgelerinde saptandı. Biyopsi sonucunda %74,6 oranında patolojik tanı elde edildi. En sık tanılar yüksek dereceli glial tümör (%49,2) ve lenfoma (%16,9) idi. Lezyon lokalizasyonu ile başvuru semptomları ve patoloji sonuçları arasında anlamlı ilişki bulunmadı (p>0,05). Patoloji tanısı ve hastanede yatış süresi arasında anlamlı fark vardı; lenfoma ve enfeksiyon tanılı hastaların yatış süresi belirgin olarak uzundu (p=0,003). Cerrahi sonrası ciddi komplikasyon izlenmedi. Sonuç: Stereotaktik biyopsi, derin yerleşimli beyin lezyonlarında güvenli, etkili ve tanı başarısı yüksek bir yöntemdir. Elde edilen patolojik tanılar, özellikle gliom, lenfoma ve enfeksiyon ayrımında tedavi planlamasına katkı sağlamaktadır. Bulgular, bu yöntemin minimal riskle doğru tanı sunarak klinik karar süreçlerinde önemli bir araç olduğunu göstermektedir.

Travmatik hemorajik kontüzyon, travmatik beyin hasarını takiben en sık gözlenen intrakraniyal lezyonlardan biridir ve sıklıkla frontal ve temporal lobları etkiler. Lezyonlar intrakraniyal basınç artışı ve herniasyon gibi ciddi sekonder komplikasyonlara neden olabilir. Kontüzyon hacminin değerlendirilmesinde yaygın olarak kullanılan ABC/2 yöntemi, lezyon takibi ve tedavi planlamasında pratik bir araçtır. Hacim artışı ≥%33 veya ≥12.5 mL olduğunda progresyondan söz edilir. Düşük Glasgow Koma Skoru (≤8), ileri yaş, antikoagülan/antiplatelet kullanımı, yüksek nötrofil/lenfosit oranı (NLR) ve monosit/lenfosit oranı (MLR) progresyonun belirteçleri arasında yer almaktadır. Tanıda bilgisayarlı tomografi hızlı ve etkili bir yöntemken, manyetik rezonans görüntüleme özellikle ödem ve mikroskobik lezyonları ortaya koymada üstündür. Tedavi yaklaşımı konservatif ve cerrahi yöntemler arasında bireyselleştirilmelidir. Komplikasyonlar arasında posttravmatik epilepsi, hidrosefali, enfeksiyonlar ve koagülopati ön plandadır. Bu nedenle erken tanı, multidisipliner yaklaşım ve zamanında müdahale, klinik sonuçları iyileştirmede kritik rol oynar. Traumatic hemorrhagic contusion is one of the most commonly observed intracranial lesions following traumatic brain injury and typically affects the frontal and temporal lobes. These lesions may result in serious secondary complications such as elevated intracranial pressure and herniation. The ABC/2 method is frequently used to estimate contusion volume and aids in both monitoring and treatment planning. A volumetric increase of ≥33% or ≥12.5 mL is considered significant for progression. Predictive factors for progression include low Glasgow Coma Scale (≤8), advanced age, use of anticoagulant/antiplatelet agents, and elevated neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR). While computed tomography provides a rapid and effective diagnostic tool, magnetic resonance imaging offers superior detection of edema and microscopic lesions. Treatment strategies should be individualized and may involve either conservative or surgical approaches. Common complications include post-traumatic epilepsy, hydrocephalus, infections, and coagulopathy. Therefore, early diagnosis, multidisciplinary management, and timely intervention play a crucial role in improving clinical outcomes.