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Öğe Association between ? arrestin 2 and filamin A gene variations with medical treatment response in acromegaly patients(EDIZIONI MINERVA MEDICA, 2021) Akdemir, Ayşe S.; Metin Armağan, Derya; Polat Korkmaz, Özge; Özkaya, Hande M.; Kadıoğlu, Pınar; Gazioğlu, NurperiBackground: Acromegaly is a disease that occurs as a result of excessive growth hormone caused by pituitary adenomas. Some acromegaly patients show resistance to somatostatin analog (SSA) treatment. Filamin-A (FLNA) and ?-arrestins are thought to play a role in the response to SSAs. We aimed to investigate the relationship between FLNA-rs782079491 and ?-arrestin-2-rs34230287 single-nucleotide polymorphisms and disease risk, as well as treatment response in patients with acromegaly in the Turkish population. Methods: The genotypes of 110 acromegaly patients and 99 controls were determined by realtime PCR. The genotype distributions were compared with clinical data on the disease. Results: There was no association between the ?-arrestin-2 gene polymorphism and the response to SSA treatment in acromegaly patients. For responder patients to SSAs, the ?-arrestin-2-rs34230287 CT+TT genotype was associated with higher microadenoma as compared with the CC genotype (p = 0.017). The FLNA polymorphism was not observed in the study group. Conclusions: We showed that there was no association between the polymorphic genotypes of FLNA and ?-arrestin-2 genes with acromegaly disease and SSAs response in the Turkish population. However, there was a relationship between ?-arrestin-2 and some of the clinical characteristics. Furthermore, the CC genotype and the C allele are risk factors associated with tumor growth rate in acromegaly patients.Öğe Caffeine, Alcohol, and Drug Use as Work Adjuncts Among Neurosurgeons. Prevalence, Contributing Factors, and Proposed Strategies(Elsevier Inc., 2024) Karampouga, Maria; Karagianni, Maria; Mihaylova, Stiliana; Aydın, Ayşegül Esen; Salokorpi, Niina; Lambrianou, Xanthoula; Tsianaka, Eleni; Janssen, Insa K.; Duran, Silvia Hernandez; Ivan, Daniela Luminita; Rodríguez-Hernandez, Ana; Broekman, Marike LD.; Gazioğlu, Nurperi; Tasiou, Anastasia; Murphy, MaryBackground: Neurosurgeons may resort to caffeine, alcohol, and various drugs to maintain peak performance as they grapple with work demands and escalated stress. The prevalence of this controversial strategy remains largely unexplored. Methods: An anonymous survey of 23 questions formulated by our research group was distributed through personal contacts and neurosurgical societies. Inquiries revolved around the use of medications and other substances for job-related reasons. Data were analyzed via regression and descriptive statistics in python. Results: In total, 215 neurosurgeons (43 residents) were included, with 213 disclosing their gender (94 females). Out of all, 9.3% were <30, 38.1% were 30–39, 44.6% were 40–59, and 7.9% were >60 years old. Most (70.7%) practiced in Europe, 18.6% in Asia, 6.5% in North and South America, and the rest in Africa or Australia. While 132 participants stated they consume caffeine to manage challenging schedules, drugs for cognitive and mood enhancement were utilized by 18 and 35 respectively. Alcohol was employed for stress relief by 28 with 4 reporting as heavy drinkers. Drugs posed a solution to sleep disorders for 82, and helped 8 others in strengthening their hand dexterity. Notably, 12 of those claiming drug use initiated it in medical school. Exercise, self-care activities, and relational support were the main alternatives sought. Ultimately, most responders recommended extending mental health assistance and raising awareness about drug use. Conclusions: Reflecting on our results on job-associated drug use by neurosurgeons, we propose the judicious use of pharmacological or nonpharmacological adjuncts, alongside the prioritization of neurosurgeons' well-being. © 2024 Elsevier Inc.Öğe Gender differences in work-life balance of European neurosurgeons(Elsevier Ltd., 2022) Lambrianou, Xanthoula; Tzerefos,Christos; Janssen, Insa K; Mihaylova, Stiliana; Aydın,Ayşegül Esen; Al-Ahmad, Selma; Broekman, Marike Ld; Gazioğlu, Nurperi; Duran, Silvia Hernandez; Ivan, Daniela Luminita; Karampouga, Maria; Magnadottir, Hulda B; Pajaj ,Ermira; Rodríguez-Hernández, Ana; Rosseau, Gail; Salokorpi, Niina; Tsianaka, Eleni; Vayssiere, Pia; Murphy, Mary; Tasiou, AnastasiaGender differences in work-life balance of European neurosurgeonsÖğe Machine learning as a clinical decision support tool for patients with acromegaly(SPRINGER, 2022) Sulu, Cem; Bektaş, Ayyüce Begüm; Şahin, Serdar; Durcan, Emre; Kara, Zehra; Demir, Ahmet Numan; Özkaya, Hande Mefkure; Tanrıöver, Necmettin; Çomunoğlu, Nil; Kızılkılıç, Osman; Gazioğlu, Nurperi; Gönen, Mehmet; Kadıoğlu, PınarObjective To develop machine learning (ML) models that predict postoperative remission, remission at last visit, and resistance to somatostatin receptor ligands (SRL) in patients with acromegaly and to determine the clinical features associated with the prognosis. Methods We studied outcomes using the area under the receiver operating characteristics (AUROC) values, which were reported as the performance metric. To determine the importance of each feature and easy interpretation, Shapley Additive explanations (SHAP) values, which help explain the outputs of ML models, are used. Results One-hundred fifty-two patients with acromegaly were included in the final analysis. The mean AUROC values resulting from 100 independent replications were 0.728 for postoperative 3 months remission status classification, 0.879 for remission at last visit classification, and 0.753 for SRL resistance status classification. Extreme gradient boosting model demonstrated that preoperative growth hormone (GH) level, age at operation, and preoperative tumor size were the most important predictors for early remission; resistance to SRL and preoperative tumor size represented the most important predictors of remission at last visit, and postoperative 3-month insulin-like growth factor 1 (IGF1) and GH levels (random and nadir) together with the sparsely granulated somatotroph adenoma subtype served as the most important predictors of SRL resistance. Conclusions ML models may serve as valuable tools in the prediction of remission and SRL resistance.Öğe Machine Learning May Be an Alternative to BIPSS in the Differential Diagnosis of ACTH-dependent Cushing Syndrome(Endocrine Society, 2025) Demir, Ahmet Numan; Ayata, Değer; Öz, Ahmet; Sulu, Cem; Kara, Zehra; Şahin, Serdar; Özaydın, Dilan; Korkmazer, Bora; Arslan, Serdar; Kızılkılıç, Osman; Çiftçi, Sema; Çelik, Özlem; Özkaya, Hande Mefkure; Tanrıöver, Necmettin; Gazioğlu, Nurperi; Kadıoğlu, PınarContext: Artificial intelligence research in the field of neuroendocrinology has accelerated. It is possible to develop noninvasive, easy-to-use and cost-effective procedures that can replace invasive procedures for the differential diagnosis of adrenocorticotropin (ACTH)-dependent Cushing syndrome (CS) by artificial intelligence. Objective: This study aimed to develop machine-learning (ML) algorithms for the differential diagnosis of ACTH-dependent CS based on biochemical and radiological features. Methods: Logistic regression algorithms were used for ML, and the area under the receiver operating characteristics curve was used to measure performance. We used Shapley contributed comments (SHAP) values, which help explain the results of the ML models to identify the meaning of each feature and facilitate interpretation. Results: A total of 106 patients, 80 with Cushing disease (CD) and 26 with ectopic ACTH syndrome (EAS), were enrolled in the study. The ML task was created to classify patients with ACTH-dependent CS into CD and EAS. The average AUROC value obtained in the cross-validation of the logistic regression model created for the classification task was 0.850. The diagnostic accuracy of the algorithm was 86%. The SHAP values indicated that the most important determinants for the model were the 2-day 2-mg dexamethasone suppression test, greater than 50% suppression in the 8-mg high-dose dexamethasone test, late-night salivary cortisol, and the diameter of the pituitary adenoma. We have also made our algorithm available to all clinicians via a user-friendly interface. Conclusion: ML algorithms have the potential to serve as an alternative decision-support tool to invasive procedures in the differential diagnosis of ACTH-dependent CS. © The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society. All rights reservedÖğe Secondary pituitary abscess: a rare complication of transsphenoidal surgery for pituitary adenoma - description of two new cases and review of the literature(Mary ann liebert, 2024) Başkurt, Ozan; Avinçsal, Benan Baysoy; Diren, Furkan; Kabataş, Serdar; Kuşoglu, Hülya; Kara, Simay; Gazioğlu, NurperiBackground: Pituitary abscess (PA), a rare complication following transsphenoidal (TS) surgery for pituitary adenoma with an incidence of 0.2%, poses a significant risk; carrying potential morbidity, recurrence, and the necessity for reoperation. Timely suspicion, diagnosis, and treatment are imperative.Patients and Methods: We present two cases and provide a literature review on the symptoms, risk factors, diagnosis, treatment, and outcomes associated with secondary PAs following TS surgery for adenoma.Results: We identified 12 articles reporting a total of 45 cases, in addition to our 2 cases. The primary symptoms were headache and visual impairment, with no fever or specific infectious parameters observed. Predominant risk factors identified included cerebrospinal fluid (CSF) leakage and prior radiotherapy (RT). Our first patient, a 45-year-old male, presented 10 weeks after TS surgery with sudden-onset symptoms, whereas our second patient, a 64-year-old female, presented 22 years postoperatively. In the first case, intraoperative CSF leakage, with the patient's history of allergic rhinitis and frequent nasal irrigation possibly contributed to the development of abscess. In the second case, RT was considered a potential risk factor. Severe headache and subclinical signs of infection associated with a cystic lesion of the pituitary gland were common findings. Both patients underwent endoscopic TS drainage and received appropriate antibiotic therapy, resulting in complete recovery without recurrence.Conclusions: When faced with severe headaches in a patient with a history of TS surgery for a pituitary adenoma, coupled with radiological evidence showing a cystic appearance with peripheral enhancement, taking a proactive approach to promptly identify and intervene in secondary PAs is essential for mitigating potential complications and optimizing patient outcomes.Öğe Should we take precautions to avoid respiratory compromise while delaying CPAP resumption following transsfenoidal surgery? An alternative approach in a patient with severe obstructive sleep apnea: case report(Springer, 2022) Yenigün, Yılmaz; Özonur, Anıl; Tuğrul, Kamil Mehmet; Özbek, Uğur; Gazioğlu, NurperiBackground We describe a patient with severe obstructive sleep apnea scheduled for transsfenoidal surgery. Early postoperative use of continuous positive airway pressure (CPAP) was considered unsafe because increased risk of intracranial complications. Methods Aiming to bypass the upper airway obstruction and thus avoid CPAP, a 6-mm nasopharyngeal airway was introduced by the surgical team under endoscopic vision. In the postoperative period and during follow-up, patient and his family did not complain about apnea/hypopnea episodes and nasopharyngeal airway was tolerated comfortably. Conclusion We recommend this technique as an alternative in obstructive sleep apnea patients undergoing transsfenoidal surgery.Öğe The Complexities of Aeronautical Transfer of Acutely Unwell Neurosurgical Patients(Elsevier Inc., 2025) Tasiou, Anastasia; Tzerefos, Christos; Karagianni, Maria; Tsianaka, Eleni; Jarratt, Mark; Gazioğlu, Nurperi; Peramatzis, Konstantinos; Broekman, Marike LD.; Rodríguez-Hernández, Ana; Ivan, Daniela L.; Janssen, Insa K.; Karampouga, MariaObjective: Neurosurgical care is difficult to access in many scenarios. Aeromedical evacuation of acutely unwell neurosurgical patients from remote, isolated, or poorly equipped locations can be considered. This article aims to provide a framework of logistical factors that deserve special consideration in the preparation of these patients for transfer. Methods: We searched all relevant medical literature, military reports, and travel industry documents on transfer of neurosurgical patients. This review was combined with a senior author's (M.J.) extensive relevant experience, to present important factors for neurosurgeons to consider during planning of aeromedical evacuation, highlighting potential preventable causes of deterioration en route. Results: Several criteria must be met for a transfer to be considered. The safe transfer of patients with craniospinal pathology requires efficient collaboration between the referring teams, the receiving units/departments, and the medical transfer service. Clear communication, qualified personnel, and appropriate transportation equipment must be available for the transfer. One must consider unique stressors during the air transfer, including the risk of hypoxia on certain types of flights. Vibration, loud noise, acceleration, and changes in barometric pressure en route may negatively affect the patient during transfer. Patient stabilization before transfer is a priority. Medical conditions that can potentially worsen in-flight should be corrected before transfer. The use of a checklist before departure is highly recommended and is included herein. The timing of transfer concerning the postoperative patient deserves special consideration. Conclusions: Although there is little published information, this review provides useful criteria and parameters needed for safe aeromedical evacuation of neurosurgical patients. © 2025 The AuthorsÖğe What to expect, when you expect the neurosurgical perspective(Churchill livingstone, 2024) Karagianni, Maria; Mihaylova, Stiliana; Tzerefos, Christos; Janssen, Insa K.; Tsianaka, Eleni; Murphy, Mary; Gazioğlu, Nurperi; Broekman, Marike L.D.; Salokorpi, Niina; Karampouga, Maria; Rodríguez-Hernández, Ana; Lambrianou, XanthoulaBackground: Women in neurosurgery often have to delay pregnancy and child-rearing because the optimum time for having children overlap with an intense period of training and/or career advancement. The purpose of the study is to investigate the personal experiences of women neurosurgeons and understand the complex interaction between pursuing a career and embracing motherhood. Methods: We employed anonymized, semi-structured interviews with women actively involved in the field of neurosurgery. Person-to-person interviews were performed online via video call. Responses were grouped and analyzed with thematic analysis. We identified recurring patterns and insights in the interview responses. Results: We included twenty-one women neurosurgeons, at various career levels. Thematic analysis revealed diverse perspectives. More than half favored a delayed pregnancy announcement. The majority perceived a workplace, social stigma attached to pregnancy. Although most of them reported adequate support from their colleagues, several explained that the support was theoretical rather than practical. Many interviewees expressed their fears about losing their surgical skills, while 57.2% had concerns regarding their physical abilities during or after pregnancy. All but one felt that female neurosurgeons should not postpone or sacrifice motherhood for their career. However, alternative paths within neurosurgery could be an option. Conclusions: Finding a way to combine a career in neurosurgery with pregnancy can be very challenging and may be vital to keep attracting quality professionals to the field. Efforts should be made to maintain the balance between career and home and to facilitate greater flexibility at the workplace for women who are pregnant and/ or child-rearing.
