Objective: Glioblastoma multiforme (GBM) is the most common malignant primary brain tumor in adults. The most common problem in the follow-up after GBM treatment is the lack of local control. This study aims to evaluate the efficacy and safety of Temozolomide (TMZ) in cases who received post-surgical radiotherapy and TMZ treatment in GBM compared to cases who received only radiotherapy treatment after surgery. Materials and Methods: The cases diagnosed with GBM were divided into two groups. The first group was divided into cases that received only radiotherapy after surgery, and the second group (combined treatment group) was divided into cases that received post-surgical radiotherapy and TMZ treatment. 28 cases who received radiotherapy and TMZ treatment after surgery and 26 cases who received only radiotherapy after surgery were included in the study. Local fractionated radiotherapy (60 Gy total dose: 2 Gyx5 days/week for 6 weeks) was applied to all cases. Only in the second group, 75 mg/m2/day 7 days/week orally, 200 mg/m2/day 5 days as monotherapy for 6 weeks, and six cycles of TMZ every 28 days were administered concomitantly. In addition to the effect of TMZ on prognosis and survival, the effects of age, gender, and resection size on progression-free survival (PSS) and overall survival (GSS) were evaluated in both groups. Results: There was no statistically significant benefit in terms of both PFS and OS in both groups for age and gender, a statistically significant benefit was found for resection size (total-subtotal). At the end of the study, PFS was 14 months in the combined treatment group and 6 months in the radiotherapy alone group (P<0.0001). OS was 16 months in the combined treatment group and 12.5 months in the radiotherapy alone group (P=0.0354). Conclusion: Combined (RT + TMZ) treatment after total surgical treatment was found to be more effective on prognosis and survival than radiotherapy alone.

Background: Successful spinal stabilization depends not only on early mechanical fixation but also on durable biological integration at the bone–implant interface. This study aimed to compare a two-stage allograft-augmented fixation strategy, intended to promote biological fixation, with conventional posterior segmental stabilization (PSS) in the treatment of screw loosening following multilevel spinal surgery for degenerative spine pathology. Methods: This retrospective comparative study included 40 patients who underwent multilevel spinal stabilization between January 2022 and February 2025, with follow-up completed by November 2025. Patients were divided into a conventional PSS group (n = 28) and a two-stage allograft-augmented fixation group (OI-focused strategy, n = 12). Demographic characteristics, comorbidity burden, length of hospital stay, complications, Visual Analog Scale (VAS), the Oswestry Disability Index (ODI), and sagittal radiographic parameters—including lumbar lordosis (LL), sagittal vertical axis (SVA), sacral slope (SS), and pelvic incidence (PI)—were evaluated preoperatively and at 1, 6, and 9 months postoperatively. Results: The groups were similar in terms of age, sex, body mass index, smoking status, and number of operated levels. Despite the significantly higher Charlson Comorbidity Index and Elixhauser Comorbidity Index scores in the OI-focused group, hospital stay was significantly shorter. VAS and ODI scores were comparable preoperatively and at 1 month; however, significantly better pain and functional outcomes were observed in the OI-focused group at 6 and 9 months. Radiologically, SVA was significantly lower in the OI-focused group at 6 and 9 months. Late differences were also observed in LL and SS, while PI remained similar between groups. Fusion-related findings were interpreted cautiously because fusion was assessed using plain radiographs and osseointegration was not directly measured. Conclusions: The two-stage allograft-augmented fixation strategy was associated with better mid-term pain control, improved functional recovery, and better preservation of selected sagittal alignment parameters compared with conventional PSS. However, these findings should be interpreted cautiously due to the retrospective design, limited sample size, imbalanced groups, absence of direct osseointegration measurement, and lack of CT-based fusion analysis.

Purpose: This study evaluated whether documented preoperative antidepressant use was associated with early outcomes after lumbar spinal fusion, with particular emphasis on postoperative gabapentinoid use.Materials and Methods: A retrospective cohort study of adults who underwent lumbar fusion have been performed. Patients with documented regular antidepressant use before surgery were compared with patients without antidepressant use. The primary endpoint was postoperative gabapentinoid use. Secondary endpoints included complications, length of stay, in-hospital mortality, and 90-day readmission. Antidepressant exposure was also analyzed by medication class.Results: Among 1,628 screened elective spinal fusion patients, 183 (11.2%) had documentation of antidepressant use and 154 met all inclusion/exclusion criteria for the final cohort: 120 controls and 34 antidepressant users. Antidepressant users were more often female (64.7% vs. 51.8) and had higher Elixhauser (1.92 vs. 1.38) and Charlson comorbidity indices (0.84 vs. 0.72). Postoperative gabapentinoid use was more frequent among patients receiving SSRIs, SNRIs, and atypical antidepressants. Complications and 90-day readmission (8.8% vs. 7.5%) ere not statistically different between groups.Conclusion: Preoperative antidepressant use was associated with higher postoperative gabapentinoid use after lumbar spinal fusion, particularly among SSRI, SNRI, and atypical antidepressant users. These findings should be interpreted as associations rather than evidence that antidepressants directly cause postoperative medication requirements.

Purpose: The aim of this study was to identify patients with acute neurological findings associated with COVID-19 and to demonstrate the effectiveness of magnetic resonance imaging (MRI) in its diagnosis. Materials and Methods: Between June 2020 and December 2021, 90 patients who were diagnosed with Covid-19 in our clinic, had pneumonia findings in the lung, acute neurological findings, and brain MRI were included in the study. Results were evaluated retrospectively for 46 patients without central nervous system (CNS) involvement and 44 patients with CNS findings. Results: The most common neurological symptoms in COVID-19 patients; Unexplained loss of consciousness by treatment (28/44, 63.6%), focal neurologic deficits (21/44, 47.7%), and seizures (9/44, 20.4%). Increased mortality, increment in the need for ventilator support, and prolonged stay in the intensive care unit were observed in patients with CNS findings. Brain MRI was performed on 44 patients with neurological symptoms. Mean age of 68.3 years (45–78) in patients undergoing MRI. Acute findings were detected in MRI of 32 patients (72%). The most common diagnoses in brain MRI were acute and subacute infarcts. Conclusion: The mechanism of CNS manifestations is still unclear, and neurological symptoms in COVID-19 patients are an important problem, especially in intensive care units. Therefore, early detection and treatment of CNS involvement are very important.

Background: Chronic subdural hematoma (cSDH) is a common neurological condition, particularly among the elderly, often presenting asymptomatically. This study aims to evaluate the efficacy of hydrocortisone as a monotherapy in patients with cSDH.Methods: In our clinic, patients over 18 years of age with newly diagnosed symptomatic cSDH detected by brain computed tomography (CT) were evaluated according to the Markwalder Grading Scale, which measures neurological outcomes from 0 to 4. Treatment was started with oral 100 mg hydrocortisone as monotherapy. A single burr hole craniotomy (BHC) was performed on the cSDH in the surgery.Results: A total of 102 patients were included in the study, with 47 assigned to the hydrocortisone group and 55 to the surgery group. The mean patient age was 66.8 years, with 58% being male. In the surgical group, 94.5% of patients exhibited favorable outcomes postoperatively, with 6.5% requiring reoperation. In the hydrocortisone group, 80.9% demonstrated clinical improvement at three months, while 19.2% required surgical intervention. Adverse events were observed in 14.9% of the hydrocortisone group and 3.6% of the surgical group. The average hospital stay was significantly shorter in the hydrocortisone group (2.9 vs. 6.8 days, p < 0.05).Conclusion: Hydrocortisone monotherapy shows potential as a viable treatment for select cSDH patients, particularly those with mild to moderate symptoms. Further prospective studies are needed to validate its long-term efficacy and safety.Keywords: hydrocortisone, chronic subdural hematoma, burr hole craniostomy, corticosteroids

Aim: To evaluate the effects of single-segment versus two-segment pedicle screw fixation on adjacent segment disease (ASDis) and lumbar sagittal balance in patients with L4-L5 spondylolisthesis. Materials and Methods: This retrospective study included 35 patients who underwent lumbar fusion for L4-L5 spondylolisthesis between January 2020 and January 2025. Patients were divided into single-segment (SS) and two-segment (TS) groups: SS (L4-L5 fusion, n = 19) and TS (L3-L4-L5 fusion, n = 16). Clinical outcomes were assessed using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). Radiological parameters, including lumbar lordosis (LL), sagittal vertical axis (SVA), and sacral slope (SCS), were measured. Adjacent segment degeneration (ASDeg) was evaluated using Modified Pfirrmann Grades. The follow-up period was 6 months postoperatively. Results: Both groups showed significant improvement in VAS and ODI scores postoperatively. At 6-month follow-up, the TS group demonstrated greater improvement (VAS: P =0.028; ODI: P =0.042). The SS group exhibited higher Pfirrmann scores, indicating greater ASDeg, compared to the TS group ( P < 0.05). The TS group showed better restoration of LL and SVA at final follow-up, though differences were not statistically significant ( P > 0.05). Conclusion: Both single-segment and two-segment fixation improve clinical and radiological outcomes in L4-L5 spondylolisthesis. However, two-segment fixation offers advantages in preventing adjacent-segment degeneration and maintaining radiographic parameters.