AIM: To examine the morphological structure of anterior lumbar spinal region. MATERIAL and METHOD... more AIM: To examine the morphological structure of anterior lumbar spinal region. MATERIAL and METHODS: Fifteen fresh human cadavers were studied in our forensic medicine institution. Within the first 24 hours after death, cadavers were subject to a routine autopsy, by which the intestines were removed and the structures adjacent to the lumbar arteries (LAs) were examined. The following characteristics of the LA were examined and recorded: diameter, number of LA, intervertebral disc, and vertebral corpus relationship, and LA anatomical variations. RESULTS: In 14 of the 15 cadavers (93.3%), the first four LAs originated from the abdominal aorta. In one (6.7%) cadaver, the fourth LA originated from the right aortic trunk together with the median sacral artery (MSA), and this was observed only in the right side. In one cadaver, the first LAs emerged as a common trunk. Twelve cadavers did not have a fifth LA. In one cadaver (6.7%), the fifth LAs emerged as in a pair, distally from the origin of the MSA. Two cadavers (13.3%) had fifth LAs that emerged from the common trunk with the MSA and this occurred only on the right side. LAs which emerged from the right side of the abdominal aorta passed under the inferior vena cava. Of the first four LA, the third LA had the largest vessel diameter, and the first LA had the narrowest vessel diameter. Fifth LAs had one of the narrowest vessel diameters of all LAs. CONCLUSION: We consider that anatomical study of LAs using fresh cadavers can be useful to ensure safer anterior lumbar spinal surgeries.
AIM: To evaluate the clinical characteristics of children who recently underwent decompressive cr... more AIM: To evaluate the clinical characteristics of children who recently underwent decompressive craniectomy (DC) due to elevated intracranial pressure (ICP) correlated to head trauma or other causes, such as ischemic insult. MATERIAL and METHODS: Twelve patients aged ≤17 years who underwent DC due to elevated ICP between 2013 and 2018 were included in the study. The clinical status of the participants, radiological characteristics, type and timing of surgery, and outcomes were recorded. RESULTS: Three female and nine male patients with a mean age of 10 years were included. The initial average Glasgow Coma Scale score was 6 (3-12). All patients presented with signs of diffuse cerebral edema and subdural hematoma of various sizes along with other intracranial pathologies. Only one patient required bilateral frontal craniectomy. In the postoperative period, three patients died, and three had severe disability. CONCLUSION: With the increasing use and success of DC in adults, this procedure can also be effective in children. Considering brain differences in children, large and well-structured clinical trials must be conducted to prevent complications and to identify the best technique, timing, and benefits of DC for children.
AIM: To explore the anatomic features of the neural foramen in particularly at the T12-L1 level i... more AIM: To explore the anatomic features of the neural foramen in particularly at the T12-L1 level in order to assess reveal the safety and efficiency of the endoscopic transforaminal approach for paramedian and foraminal disc herniations at this level. MATERIAL and METHODS: The study included 15 fresh human cadavers. The soft tissues were removed at the T12-L1 level and bony tissues, were exposed including the transverse processes. The bilateral facets and pars interarticulares at this level were resected revealing the foraminal anatomy and exiting roots. The anatomical structures constituting the triangular safe working zone (TSWZ) were explored. The nerve root length, nerve root width, nerve root angle, TSWZ height, and base of TSWZ base, nerve root width, nerve root angle and disc height were recorded. RESULTS: The root length is the hypotenuse of the TSWZ between the axilla of the exiting root and the lateral margin of the pedicle, and the mean root length was 14.94 ± 2.45 mm. The dural height is the interval between the axilla of the exiting nerve root axilla and the superior end plate of the caudal vertebra, and the mean of the dural height was 10.95 ± 1.74 mm. The base of TSWZ is the distance between the lateral margin of the dural sac and the medial margin of the exiting root, and the mean measurement for the base measurement was 11.83 ± 2.26 mm. CONCLUSION: According to the results data from our cadaveric study, we believe that Kambin's triangular working zone is a safe area to consider for the endoscopic transforaminal approach at the T12-L1 level, especially for paramedian and foraminal disc herniations.
High-frequency oscillations in local field potentials recorded with intracranial EEG are putative... more High-frequency oscillations in local field potentials recorded with intracranial EEG are putative biomarkers of seizure onset zones in epileptic brain. However, localized 80-500 Hz oscillations can also be recorded from normal and non-epileptic cerebral structures. When defined only by rate or frequency, physiological high-frequency oscillations are indistinguishable from pathological ones, which limit their application in epilepsy presurgical planning. We hypothesized that pathological high-frequency oscillations occur in a repetitive fashion with a similar waveform morphology that specifically indicates seizure onset zones. We investigated the waveform patterns of automatically detected high-frequency oscillations in 13 epilepsy patients and five control subjects, with an average of 73 subdural and intracerebral electrodes recorded per patient. The repetitive oscillatory waveforms were identified by using a pipeline of unsupervised machine learning techniques and were then correla...
Corrective craniosynostosis surgery is often associated with a large amount of blood loss and met... more Corrective craniosynostosis surgery is often associated with a large amount of blood loss and metabolic disturbances. In the present study, we investigated the severity, duration of metabolic disturbances, and causal risk factors in infants. A retrospective analysis was performed of 36 infants who underwent craniosynostosis surgery. We analyzed the following: demographics, duration of surgery, intraoperative blood loss, RBC, FFP and fluids transfused, urine output, hemodynamic parameters, and electrolyte and base deficit (BD) values. The lowest intraoperative BD value and time required (period I: <6 h; period II: 6-12 h; period III: >12 h) for BD values to return to normal (-4 to +2) in the postoperative period were determined. In addition, we recorded the postoperative length of stay in the ICU and hospital, postoperative blood loss, and early complications. We detected that 88 % of the patients had subnormal BD levels and 22 % had metabolic acidosis. The lowest average BD measured during the operation was -8.4 ± 2.6 mmol/l. We carried out a multiple regression analysis, which revealed that lower BD values were associated with a longer duration of hypotension (p = 0.002, R(2) = 0.453) and greater intraoperative blood loss (p = 0.002, R(2) = 0.674). We examined the amount of intraoperative blood loss and found that that there were fewer blood product transfusions in period I patients and longer hypotensive episodes in period III patients. Also, a negative correlation was detected between the lowest intraoperative BD value with ICU duration (p = 0.004, r = -0.466) and hospital stay (p < 0.001, r = -0.764). Almost all patients developed intraoperative negative BD, which was prolonged in the postoperative period. The most important risk factors for developing negative BD are the amount of blood loss and duration of hypotension.
Introduction: The supraorbital keyhole approach for anterior cranial base lesions has been increa... more Introduction: The supraorbital keyhole approach for anterior cranial base lesions has been increasingly used in clinical practice. Anatomical studies focusing on the endoscopic anatomy via this approach are few, although the microscopic anatomy has been well studied. The aim of this study is to describe the anatomical features and surgical exposure provided by the endoscopic supraorbital keyhole approach using quantitative measurements. Materials and Methods: Nine formalin-fixed human cadavers from the inventory of the Anatomy department were used. A total of 18 supraorbital keyhole cranitomies were conducted. The distances between the target anatomical structures and the dura mater at the craniotomy site, and the distances between deep anatomical structures were measured with purpose-designed hooks. Results: The distance between the dura mater and optic canal was measured as 69.5 ± 6.7 mm (62-83 mm); optic chiasm as 76.2 ± 5.4 mm (67-86 mm); anterior communicating artery as 82.6 ± ...
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES, 2008
In this study we have discussed the factors that affect our surgical results according to our exp... more In this study we have discussed the factors that affect our surgical results according to our experience on patients who were admitted to our hospital's Emergency Surgery Department for civilian craniocerebral gunshot wounds between 1997 and 2006. The clinical and radiological findings of 82 patients (74 males, 8 females) who were treated for civilian craniocerebral gunshot wounds were retrospectively recorded. Neurological and physical examination, cranial computerized tomography (CCT) findings, trauma types, treatment modalities, prognosis, complications, morbidity and mortality rates were analyzed. Seventy-four (90%) of the patients were male, the mean age was 29.2 year. The Glasgow Coma Scores (GCS) during admission were as following respectively: 3-5 in 35 patients, 6-8 in 9 patients, 9-12 in 19 patients and 13-15 in 19 patients. According to their radiological findings, most commonly subdural hematoma, intracerebral hematoma, multiple contusion, depressed fracture and suba...
Symptomatic lumbar spinal stenosis produces gradually progressive back and leg pain with standing... more Symptomatic lumbar spinal stenosis produces gradually progressive back and leg pain with standing and walking, relieved by sitting or lying. One of the uncommon symptoms is involuntary intermittent penile erection due to spinal canal stenosis. This symptom is very rare and often forgotten when history is taken. In this case report, a patient suffering from intermittent priapism due to degenerative spinal canal stenosis and spondylolisthesis is described. On admission his symptoms were intermittent neurogenic claudication and involuntary erection provoked by walking a short distance. Bilateral laminectomy and posterior fusion was performed. His symptoms resolved over the first postoperative days. Cauda equina compression due to LSS may rarely cause intermittent priapism. This rare symptom should not be forgotten when taking the patient's history and should also be kept in mind during follow-up.
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES, 2006
Fractures of the clivus are often associated with severe head trauma and have high mortality rate... more Fractures of the clivus are often associated with severe head trauma and have high mortality rates due to coexisting injury of the adjacent vessels, brain stem and lower cranial nerves. An early diagnosis is often not possible because of adherent problems, high mortality rate and inadequacy of emergency imaging. Diagnosis has recently become easier with high resolution bone window computed tomography studies. In this study, radiological and clinical findings of three patients with longitudinal clival fractures and severe head trauma have been presented and associated injuries and prognostic issues are discussed with reference to the limited number of similar cases in the English literature.
A case of an intrasellar germinoma leading to pituitary stalk thickening is reported. The patient... more A case of an intrasellar germinoma leading to pituitary stalk thickening is reported. The patient, a 24-year old woman, presented with hyperprolactinemia, secondary hypothyroidism and hypogonadotropic hypogonadism with no evidence of diabetes insipidus. Cerebrospinal fluid (CSF) examination revealed an increased number of lymphocytes and histiocytes. Although b-HCG concentration was normal (< 2 mIU/mL) in the CSF, increased b-HCG concentration was detected in the serum. Systemic glucocorticoid treatment led to a decrease in CSF cell count, but no regression of the sellar mass was noted. A diagnostic biopsy was performed and showed an intrasellar germinoma. The patient underwent conventional radiotherapy. Complete resolution of the mass lesion and normalization of b-HCG concentration in the serum were observed three months after radiotherapy. The presence of intrasellar mass lesion in association with pituitary stalk thickening may cause difficulties in the differential diagnosis. Histopathological examination is essential in equivocal cases in order to reach accurate diagnosis and applying the most appropriate therapy.
ABSTRACT BackgroundEarly radiological diagnosis of vasospasm as well as the detection of ischemic... more ABSTRACT BackgroundEarly radiological diagnosis of vasospasm as well as the detection of ischemic areas and the definition of cerebral perfusion changes may have an impact on the current unfavorable results in patients with vasopasm. We investigated diffusion weighted (DW) and perfusion weighted (PW) magnetic resonance (MR) changes together with catheter angiography findings and tried to correlate radiological and clinical findings. MethodTwenty patients (11 females, 9 males, 10–71 years old) with aneurysmal subarachnoid haemorrhage and admitted by the Neurosurgery Department at the Istanbul School of Medicine between December 2003 and March 2006 were included in the study. Thirteen patients were World Federation of Neurological Societies (WFNS) grade I and 7 were WFNS grade II on admission. All patients underwent angiography pre- and postoperatively. Cranial magnetic resonance imaging (MRI) with diffusion weighted imaging (DWI) and perfusion weighted imaging (PWI) was performed in all patients. Radiological data was assessed by two neuroradiologists. FindingsAll patients underwent surgery (13 microsurgical clipping, 7 coil embolization) for a total of 23 aneurysms. Angiographic vasospasm was detected in 14 patients and clinical vasospasm in 7. DWI and PWI abnormalities were detected in 12 patients. Perfusion MRI findings were classified as prolongation of time to peak (TTP) (normal, 2–4 sec, 4–6 sec and &gt;6 sec). Reversibility was investigated on MR control scans. There was relatively good correlation between clinical and perfusion MR findings. Significant DWI abnormalities were not very frequent even in patients with clinical signs. ConclusionsDWI and PWI MR have provided an insight into hemodynamic and metabolic changes in vasospasm. Many issues are not yet clear and no study carried out so far is large enough for drawing significant conclusions. In this study, multimodality MR detected early ischemic changes in vasospasm.
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES, 2006
In this study, we evaluated the cause and the clinical course of neurogenic pulmonary edema which... more In this study, we evaluated the cause and the clinical course of neurogenic pulmonary edema which has developed abruptly in some of the patients in the neurosurgical intensive care unit. We evaluated 223 patients in the neurosurgical ICU (116 males; 107 females; mean age 44.4+/-19.5). Five of these had worsening in neurological evaluation and oxygenation and were diagnosed as having a neurogenic pulmonary edema. Patients with pneumonia were excluded from the study. We identified acute hydrocephaly in three patients and re-bleeding of an aneurysm in one as the cause of neurogenic pulmonary edema. No cause could be identified in the remaining patient. Although four patients could be discharged from the ICU, one died due to multiorgan failure. Physicians should be careful about neurogenic pulmonary edema, a life-threatening clinical condition, that develops within hours of a neurologic event and usually resolves with neurologic recovery.
Blood blister-like aneurysms (BBAs) are fragile and difficult to treat. Routine surgical and endo... more Blood blister-like aneurysms (BBAs) are fragile and difficult to treat. Routine surgical and endovascular treatment methods, such as clipping, clip wrapping, primary coiling, or stent assisted coiling, have relatively high morbidity and mortality rates. In this study, we report clinical and angiographic results for treatment of ruptured BBAs using flow diverter stents. We retrospectively reviewed patients who presented with subarachnoid hemorrhages caused by rupture of BBAs and who were treated using flow diverter stents at three neurointervention centers between January 2009 and January 2013. Clinical and angiographic findings, together with the procedural data and follow-up results, are reported. 11 patients were identified in this study. BBAs were located on the supraclinoid internal carotid artery (nine patients) and basilar arteries (two patients). Eight patients were treated by implantation of a single flow diverter stent. Two flow diverter stents were telescopically deployed in each of three patients. The procedures were successful in all cases. No acute complications developed in any case. One patient who had an initial Hess-Hunt grade 4 died of septicemia 2 weeks after the procedure (9%). Another patient developed a minor stroke caused by parent artery thrombosis (9%). Control angiographies performed 3 and 6 months post stenting revealed complete occlusion of the aneurysms in all of the remaining nine patients (82%). 10 of the 11 patients (92%) had good clinical outcomes (modified Rankin Scale score ≤2). Implantation of flow diverter stents seems to be a safe and feasible alternative for treatment of ruptured BBAs.
Background and PurposezzThe aim of this study was to elucidate the clinical features, prothrombot... more Background and PurposezzThe aim of this study was to elucidate the clinical features, prothrombotic risk factors, and outcome of pediatric Moyamoya patients. MethodszzPatients diagnosed with Moyamoya disease at a tertiary center between January 2000 and December 2006 were enrolled in this study. The clinical presentations, underlying diseases, prothrombotic risk factors, family history of thrombosis, radiological findings, treatment, and outcome of the patients were reviewed retrospectively. ResultszzEight patients with angiographically proven Moyamoya disease were identified, one of whom had neurofibromatosis type I and one had Down syndrome. The age at diagnosis varied between 19 months and 11 years (73.4±41.8 months, mean±SD). The follow-up period after diagnosis was 52.5±14.8 months. In six patients, the initial clinical presentation was hemiparesis. None of the patients had any identifiable prothrombotic factors. Despite medical and surgical treatment, three patients had recurrences and one died. Only two patients recovered without sequelae. ConclusionszzThe value of prothrombotic risk factor evaluation appears to be limited in Moyamoya patients; the outcome for pediatric patients remains dismal.
Object Traumatic posterior fossa epidural hematoma (PFEDH) is rare, but among children it may hav... more Object Traumatic posterior fossa epidural hematoma (PFEDH) is rare, but among children it may have a slightly higher incidence. With the widespread use of CT scanning, the diagnosis of PFEDH can be established more accurately, leading to an increased incidence of the lesion and possibly to a better patient prognosis. This study presents 40 pediatric cases with PFEDH. Methods The authors assessed the type of trauma, clinical findings on admission, Glasgow Coma Scale scores, CT findings (thickness of the hematoma, bone fracture, compression of the fourth ventricle, and ventricle enlargement), type of treatment, clinical course, and prognosis. Early postoperative CT scans (within the first 6 hours) were obtained and reviewed in all surgical cases. Results Twenty-nine patients underwent surgery and 11 patients received conservative therapy and close follow-up. All patients fared well, and there was no surgical mortality or morbidity. Conclusions Based on the data in this large series, t...
Turkish Journal of Trauma and Emergency Surgery, 2013
We investigated the individual and combined effects of magnesium sulphate, which is an N-Methyl-D... more We investigated the individual and combined effects of magnesium sulphate, which is an N-Methyl-D aspartate receptor antagonist (NMDA), and z-LEHD-FMK, which is a caspase 9 inhibitor, on the genesis of secondary injury in a rat spinal cord injury model. We aimed to minimize the effects of secondary injury in spinal cord trauma by choosing these two agents which served to block the two major mechanisms of cell loss, apoptosis and necrosis. METHODS The drugs were given to the subjects according to their groups, either in singular or combined fashion. For motor examination, the subjects were kept under close clinical evaluation for five days. Histopathological examination and the emerging spinal cord samples were prepared with haematoxylene-eosin and Tunel techniques. RESULTS A statistically significant difference in favor of the treatment groups has been found between the treatment and control groups in terms of histological data. However, there was no difference in the evaluation of motor examination between trauma and treatment groups. CONCLUSION We have found no difference between the individual and combined uses of MgSO 4 and z-LEHD-FMK in the prevention of secondary injury; however, there were better histological results in the treatment groups compared to trauma and control groups which gives us hope for future investigations.
Hydatid disease is a life-threatening parasitic infestation caused by Echinococcus granulosus. In... more Hydatid disease is a life-threatening parasitic infestation caused by Echinococcus granulosus. Infection with E. granulosus typically results in the formation of hydatid cysts in liver, lungs, kidney and spleen. Majority of the intracranial cysts are secondary and solitary. Multiple primary cerebral cysts are uncommon. Surgical and medical management of a 14-year-old boy with multiple primary hydatid cysts are presented. 14 cysts, which were symptomatic due to their mass effect, were surgically removed, whereas a deep-seated asymptomatic cyst was followed-up with medical treatment. Despite proper antibiotic regimen the patient was admitted with epileptic seizures six months later. The deep-seated lesion was also surgically removed. Intraoperative observations and pathological examination demonstrated different characteristics, with pericystic gliosis, gel-like cyst content and death scolices within the cavity. In addition to the fact, that the presented case is an additional example for the rare primary multiple cerebral hydatid cysts, to our knowledge it is the first case of a dead cerebral hydatid cyst, causing symptoms despite effective medical treatment.
AIM: To examine the morphological structure of anterior lumbar spinal region. MATERIAL and METHOD... more AIM: To examine the morphological structure of anterior lumbar spinal region. MATERIAL and METHODS: Fifteen fresh human cadavers were studied in our forensic medicine institution. Within the first 24 hours after death, cadavers were subject to a routine autopsy, by which the intestines were removed and the structures adjacent to the lumbar arteries (LAs) were examined. The following characteristics of the LA were examined and recorded: diameter, number of LA, intervertebral disc, and vertebral corpus relationship, and LA anatomical variations. RESULTS: In 14 of the 15 cadavers (93.3%), the first four LAs originated from the abdominal aorta. In one (6.7%) cadaver, the fourth LA originated from the right aortic trunk together with the median sacral artery (MSA), and this was observed only in the right side. In one cadaver, the first LAs emerged as a common trunk. Twelve cadavers did not have a fifth LA. In one cadaver (6.7%), the fifth LAs emerged as in a pair, distally from the origin of the MSA. Two cadavers (13.3%) had fifth LAs that emerged from the common trunk with the MSA and this occurred only on the right side. LAs which emerged from the right side of the abdominal aorta passed under the inferior vena cava. Of the first four LA, the third LA had the largest vessel diameter, and the first LA had the narrowest vessel diameter. Fifth LAs had one of the narrowest vessel diameters of all LAs. CONCLUSION: We consider that anatomical study of LAs using fresh cadavers can be useful to ensure safer anterior lumbar spinal surgeries.
AIM: To evaluate the clinical characteristics of children who recently underwent decompressive cr... more AIM: To evaluate the clinical characteristics of children who recently underwent decompressive craniectomy (DC) due to elevated intracranial pressure (ICP) correlated to head trauma or other causes, such as ischemic insult. MATERIAL and METHODS: Twelve patients aged ≤17 years who underwent DC due to elevated ICP between 2013 and 2018 were included in the study. The clinical status of the participants, radiological characteristics, type and timing of surgery, and outcomes were recorded. RESULTS: Three female and nine male patients with a mean age of 10 years were included. The initial average Glasgow Coma Scale score was 6 (3-12). All patients presented with signs of diffuse cerebral edema and subdural hematoma of various sizes along with other intracranial pathologies. Only one patient required bilateral frontal craniectomy. In the postoperative period, three patients died, and three had severe disability. CONCLUSION: With the increasing use and success of DC in adults, this procedure can also be effective in children. Considering brain differences in children, large and well-structured clinical trials must be conducted to prevent complications and to identify the best technique, timing, and benefits of DC for children.
AIM: To explore the anatomic features of the neural foramen in particularly at the T12-L1 level i... more AIM: To explore the anatomic features of the neural foramen in particularly at the T12-L1 level in order to assess reveal the safety and efficiency of the endoscopic transforaminal approach for paramedian and foraminal disc herniations at this level. MATERIAL and METHODS: The study included 15 fresh human cadavers. The soft tissues were removed at the T12-L1 level and bony tissues, were exposed including the transverse processes. The bilateral facets and pars interarticulares at this level were resected revealing the foraminal anatomy and exiting roots. The anatomical structures constituting the triangular safe working zone (TSWZ) were explored. The nerve root length, nerve root width, nerve root angle, TSWZ height, and base of TSWZ base, nerve root width, nerve root angle and disc height were recorded. RESULTS: The root length is the hypotenuse of the TSWZ between the axilla of the exiting root and the lateral margin of the pedicle, and the mean root length was 14.94 ± 2.45 mm. The dural height is the interval between the axilla of the exiting nerve root axilla and the superior end plate of the caudal vertebra, and the mean of the dural height was 10.95 ± 1.74 mm. The base of TSWZ is the distance between the lateral margin of the dural sac and the medial margin of the exiting root, and the mean measurement for the base measurement was 11.83 ± 2.26 mm. CONCLUSION: According to the results data from our cadaveric study, we believe that Kambin's triangular working zone is a safe area to consider for the endoscopic transforaminal approach at the T12-L1 level, especially for paramedian and foraminal disc herniations.
High-frequency oscillations in local field potentials recorded with intracranial EEG are putative... more High-frequency oscillations in local field potentials recorded with intracranial EEG are putative biomarkers of seizure onset zones in epileptic brain. However, localized 80-500 Hz oscillations can also be recorded from normal and non-epileptic cerebral structures. When defined only by rate or frequency, physiological high-frequency oscillations are indistinguishable from pathological ones, which limit their application in epilepsy presurgical planning. We hypothesized that pathological high-frequency oscillations occur in a repetitive fashion with a similar waveform morphology that specifically indicates seizure onset zones. We investigated the waveform patterns of automatically detected high-frequency oscillations in 13 epilepsy patients and five control subjects, with an average of 73 subdural and intracerebral electrodes recorded per patient. The repetitive oscillatory waveforms were identified by using a pipeline of unsupervised machine learning techniques and were then correla...
Corrective craniosynostosis surgery is often associated with a large amount of blood loss and met... more Corrective craniosynostosis surgery is often associated with a large amount of blood loss and metabolic disturbances. In the present study, we investigated the severity, duration of metabolic disturbances, and causal risk factors in infants. A retrospective analysis was performed of 36 infants who underwent craniosynostosis surgery. We analyzed the following: demographics, duration of surgery, intraoperative blood loss, RBC, FFP and fluids transfused, urine output, hemodynamic parameters, and electrolyte and base deficit (BD) values. The lowest intraoperative BD value and time required (period I: &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;6 h; period II: 6-12 h; period III: &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;12 h) for BD values to return to normal (-4 to +2) in the postoperative period were determined. In addition, we recorded the postoperative length of stay in the ICU and hospital, postoperative blood loss, and early complications. We detected that 88 % of the patients had subnormal BD levels and 22 % had metabolic acidosis. The lowest average BD measured during the operation was -8.4 ± 2.6 mmol/l. We carried out a multiple regression analysis, which revealed that lower BD values were associated with a longer duration of hypotension (p = 0.002, R(2) = 0.453) and greater intraoperative blood loss (p = 0.002, R(2) = 0.674). We examined the amount of intraoperative blood loss and found that that there were fewer blood product transfusions in period I patients and longer hypotensive episodes in period III patients. Also, a negative correlation was detected between the lowest intraoperative BD value with ICU duration (p = 0.004, r = -0.466) and hospital stay (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001, r = -0.764). Almost all patients developed intraoperative negative BD, which was prolonged in the postoperative period. The most important risk factors for developing negative BD are the amount of blood loss and duration of hypotension.
Introduction: The supraorbital keyhole approach for anterior cranial base lesions has been increa... more Introduction: The supraorbital keyhole approach for anterior cranial base lesions has been increasingly used in clinical practice. Anatomical studies focusing on the endoscopic anatomy via this approach are few, although the microscopic anatomy has been well studied. The aim of this study is to describe the anatomical features and surgical exposure provided by the endoscopic supraorbital keyhole approach using quantitative measurements. Materials and Methods: Nine formalin-fixed human cadavers from the inventory of the Anatomy department were used. A total of 18 supraorbital keyhole cranitomies were conducted. The distances between the target anatomical structures and the dura mater at the craniotomy site, and the distances between deep anatomical structures were measured with purpose-designed hooks. Results: The distance between the dura mater and optic canal was measured as 69.5 ± 6.7 mm (62-83 mm); optic chiasm as 76.2 ± 5.4 mm (67-86 mm); anterior communicating artery as 82.6 ± ...
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES, 2008
In this study we have discussed the factors that affect our surgical results according to our exp... more In this study we have discussed the factors that affect our surgical results according to our experience on patients who were admitted to our hospital's Emergency Surgery Department for civilian craniocerebral gunshot wounds between 1997 and 2006. The clinical and radiological findings of 82 patients (74 males, 8 females) who were treated for civilian craniocerebral gunshot wounds were retrospectively recorded. Neurological and physical examination, cranial computerized tomography (CCT) findings, trauma types, treatment modalities, prognosis, complications, morbidity and mortality rates were analyzed. Seventy-four (90%) of the patients were male, the mean age was 29.2 year. The Glasgow Coma Scores (GCS) during admission were as following respectively: 3-5 in 35 patients, 6-8 in 9 patients, 9-12 in 19 patients and 13-15 in 19 patients. According to their radiological findings, most commonly subdural hematoma, intracerebral hematoma, multiple contusion, depressed fracture and suba...
Symptomatic lumbar spinal stenosis produces gradually progressive back and leg pain with standing... more Symptomatic lumbar spinal stenosis produces gradually progressive back and leg pain with standing and walking, relieved by sitting or lying. One of the uncommon symptoms is involuntary intermittent penile erection due to spinal canal stenosis. This symptom is very rare and often forgotten when history is taken. In this case report, a patient suffering from intermittent priapism due to degenerative spinal canal stenosis and spondylolisthesis is described. On admission his symptoms were intermittent neurogenic claudication and involuntary erection provoked by walking a short distance. Bilateral laminectomy and posterior fusion was performed. His symptoms resolved over the first postoperative days. Cauda equina compression due to LSS may rarely cause intermittent priapism. This rare symptom should not be forgotten when taking the patient's history and should also be kept in mind during follow-up.
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES, 2006
Fractures of the clivus are often associated with severe head trauma and have high mortality rate... more Fractures of the clivus are often associated with severe head trauma and have high mortality rates due to coexisting injury of the adjacent vessels, brain stem and lower cranial nerves. An early diagnosis is often not possible because of adherent problems, high mortality rate and inadequacy of emergency imaging. Diagnosis has recently become easier with high resolution bone window computed tomography studies. In this study, radiological and clinical findings of three patients with longitudinal clival fractures and severe head trauma have been presented and associated injuries and prognostic issues are discussed with reference to the limited number of similar cases in the English literature.
A case of an intrasellar germinoma leading to pituitary stalk thickening is reported. The patient... more A case of an intrasellar germinoma leading to pituitary stalk thickening is reported. The patient, a 24-year old woman, presented with hyperprolactinemia, secondary hypothyroidism and hypogonadotropic hypogonadism with no evidence of diabetes insipidus. Cerebrospinal fluid (CSF) examination revealed an increased number of lymphocytes and histiocytes. Although b-HCG concentration was normal (< 2 mIU/mL) in the CSF, increased b-HCG concentration was detected in the serum. Systemic glucocorticoid treatment led to a decrease in CSF cell count, but no regression of the sellar mass was noted. A diagnostic biopsy was performed and showed an intrasellar germinoma. The patient underwent conventional radiotherapy. Complete resolution of the mass lesion and normalization of b-HCG concentration in the serum were observed three months after radiotherapy. The presence of intrasellar mass lesion in association with pituitary stalk thickening may cause difficulties in the differential diagnosis. Histopathological examination is essential in equivocal cases in order to reach accurate diagnosis and applying the most appropriate therapy.
ABSTRACT BackgroundEarly radiological diagnosis of vasospasm as well as the detection of ischemic... more ABSTRACT BackgroundEarly radiological diagnosis of vasospasm as well as the detection of ischemic areas and the definition of cerebral perfusion changes may have an impact on the current unfavorable results in patients with vasopasm. We investigated diffusion weighted (DW) and perfusion weighted (PW) magnetic resonance (MR) changes together with catheter angiography findings and tried to correlate radiological and clinical findings. MethodTwenty patients (11 females, 9 males, 10–71 years old) with aneurysmal subarachnoid haemorrhage and admitted by the Neurosurgery Department at the Istanbul School of Medicine between December 2003 and March 2006 were included in the study. Thirteen patients were World Federation of Neurological Societies (WFNS) grade I and 7 were WFNS grade II on admission. All patients underwent angiography pre- and postoperatively. Cranial magnetic resonance imaging (MRI) with diffusion weighted imaging (DWI) and perfusion weighted imaging (PWI) was performed in all patients. Radiological data was assessed by two neuroradiologists. FindingsAll patients underwent surgery (13 microsurgical clipping, 7 coil embolization) for a total of 23 aneurysms. Angiographic vasospasm was detected in 14 patients and clinical vasospasm in 7. DWI and PWI abnormalities were detected in 12 patients. Perfusion MRI findings were classified as prolongation of time to peak (TTP) (normal, 2–4 sec, 4–6 sec and &gt;6 sec). Reversibility was investigated on MR control scans. There was relatively good correlation between clinical and perfusion MR findings. Significant DWI abnormalities were not very frequent even in patients with clinical signs. ConclusionsDWI and PWI MR have provided an insight into hemodynamic and metabolic changes in vasospasm. Many issues are not yet clear and no study carried out so far is large enough for drawing significant conclusions. In this study, multimodality MR detected early ischemic changes in vasospasm.
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES, 2006
In this study, we evaluated the cause and the clinical course of neurogenic pulmonary edema which... more In this study, we evaluated the cause and the clinical course of neurogenic pulmonary edema which has developed abruptly in some of the patients in the neurosurgical intensive care unit. We evaluated 223 patients in the neurosurgical ICU (116 males; 107 females; mean age 44.4+/-19.5). Five of these had worsening in neurological evaluation and oxygenation and were diagnosed as having a neurogenic pulmonary edema. Patients with pneumonia were excluded from the study. We identified acute hydrocephaly in three patients and re-bleeding of an aneurysm in one as the cause of neurogenic pulmonary edema. No cause could be identified in the remaining patient. Although four patients could be discharged from the ICU, one died due to multiorgan failure. Physicians should be careful about neurogenic pulmonary edema, a life-threatening clinical condition, that develops within hours of a neurologic event and usually resolves with neurologic recovery.
Blood blister-like aneurysms (BBAs) are fragile and difficult to treat. Routine surgical and endo... more Blood blister-like aneurysms (BBAs) are fragile and difficult to treat. Routine surgical and endovascular treatment methods, such as clipping, clip wrapping, primary coiling, or stent assisted coiling, have relatively high morbidity and mortality rates. In this study, we report clinical and angiographic results for treatment of ruptured BBAs using flow diverter stents. We retrospectively reviewed patients who presented with subarachnoid hemorrhages caused by rupture of BBAs and who were treated using flow diverter stents at three neurointervention centers between January 2009 and January 2013. Clinical and angiographic findings, together with the procedural data and follow-up results, are reported. 11 patients were identified in this study. BBAs were located on the supraclinoid internal carotid artery (nine patients) and basilar arteries (two patients). Eight patients were treated by implantation of a single flow diverter stent. Two flow diverter stents were telescopically deployed in each of three patients. The procedures were successful in all cases. No acute complications developed in any case. One patient who had an initial Hess-Hunt grade 4 died of septicemia 2 weeks after the procedure (9%). Another patient developed a minor stroke caused by parent artery thrombosis (9%). Control angiographies performed 3 and 6 months post stenting revealed complete occlusion of the aneurysms in all of the remaining nine patients (82%). 10 of the 11 patients (92%) had good clinical outcomes (modified Rankin Scale score ≤2). Implantation of flow diverter stents seems to be a safe and feasible alternative for treatment of ruptured BBAs.
Background and PurposezzThe aim of this study was to elucidate the clinical features, prothrombot... more Background and PurposezzThe aim of this study was to elucidate the clinical features, prothrombotic risk factors, and outcome of pediatric Moyamoya patients. MethodszzPatients diagnosed with Moyamoya disease at a tertiary center between January 2000 and December 2006 were enrolled in this study. The clinical presentations, underlying diseases, prothrombotic risk factors, family history of thrombosis, radiological findings, treatment, and outcome of the patients were reviewed retrospectively. ResultszzEight patients with angiographically proven Moyamoya disease were identified, one of whom had neurofibromatosis type I and one had Down syndrome. The age at diagnosis varied between 19 months and 11 years (73.4±41.8 months, mean±SD). The follow-up period after diagnosis was 52.5±14.8 months. In six patients, the initial clinical presentation was hemiparesis. None of the patients had any identifiable prothrombotic factors. Despite medical and surgical treatment, three patients had recurrences and one died. Only two patients recovered without sequelae. ConclusionszzThe value of prothrombotic risk factor evaluation appears to be limited in Moyamoya patients; the outcome for pediatric patients remains dismal.
Object Traumatic posterior fossa epidural hematoma (PFEDH) is rare, but among children it may hav... more Object Traumatic posterior fossa epidural hematoma (PFEDH) is rare, but among children it may have a slightly higher incidence. With the widespread use of CT scanning, the diagnosis of PFEDH can be established more accurately, leading to an increased incidence of the lesion and possibly to a better patient prognosis. This study presents 40 pediatric cases with PFEDH. Methods The authors assessed the type of trauma, clinical findings on admission, Glasgow Coma Scale scores, CT findings (thickness of the hematoma, bone fracture, compression of the fourth ventricle, and ventricle enlargement), type of treatment, clinical course, and prognosis. Early postoperative CT scans (within the first 6 hours) were obtained and reviewed in all surgical cases. Results Twenty-nine patients underwent surgery and 11 patients received conservative therapy and close follow-up. All patients fared well, and there was no surgical mortality or morbidity. Conclusions Based on the data in this large series, t...
Turkish Journal of Trauma and Emergency Surgery, 2013
We investigated the individual and combined effects of magnesium sulphate, which is an N-Methyl-D... more We investigated the individual and combined effects of magnesium sulphate, which is an N-Methyl-D aspartate receptor antagonist (NMDA), and z-LEHD-FMK, which is a caspase 9 inhibitor, on the genesis of secondary injury in a rat spinal cord injury model. We aimed to minimize the effects of secondary injury in spinal cord trauma by choosing these two agents which served to block the two major mechanisms of cell loss, apoptosis and necrosis. METHODS The drugs were given to the subjects according to their groups, either in singular or combined fashion. For motor examination, the subjects were kept under close clinical evaluation for five days. Histopathological examination and the emerging spinal cord samples were prepared with haematoxylene-eosin and Tunel techniques. RESULTS A statistically significant difference in favor of the treatment groups has been found between the treatment and control groups in terms of histological data. However, there was no difference in the evaluation of motor examination between trauma and treatment groups. CONCLUSION We have found no difference between the individual and combined uses of MgSO 4 and z-LEHD-FMK in the prevention of secondary injury; however, there were better histological results in the treatment groups compared to trauma and control groups which gives us hope for future investigations.
Hydatid disease is a life-threatening parasitic infestation caused by Echinococcus granulosus. In... more Hydatid disease is a life-threatening parasitic infestation caused by Echinococcus granulosus. Infection with E. granulosus typically results in the formation of hydatid cysts in liver, lungs, kidney and spleen. Majority of the intracranial cysts are secondary and solitary. Multiple primary cerebral cysts are uncommon. Surgical and medical management of a 14-year-old boy with multiple primary hydatid cysts are presented. 14 cysts, which were symptomatic due to their mass effect, were surgically removed, whereas a deep-seated asymptomatic cyst was followed-up with medical treatment. Despite proper antibiotic regimen the patient was admitted with epileptic seizures six months later. The deep-seated lesion was also surgically removed. Intraoperative observations and pathological examination demonstrated different characteristics, with pericystic gliosis, gel-like cyst content and death scolices within the cavity. In addition to the fact, that the presented case is an additional example for the rare primary multiple cerebral hydatid cysts, to our knowledge it is the first case of a dead cerebral hydatid cyst, causing symptoms despite effective medical treatment.
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