44th Annual Meeting of International Society for Pediatric Neurosurgery, Kobe, Japan, Oct 23-27, ... more 44th Annual Meeting of International Society for Pediatric Neurosurgery, Kobe, Japan, Oct 23-27, 2016 This supplement was not sponsored by outside commercial interests. It was funded entirely by the publisher. Graciela Zuccaro, ISPN President Mami Yamasaki, ISPN 2016 Annual Meeting Chair Graham Fieggen, ISPN 2016 Scientific Committee Chair Tony Figaji, ISPN 2016 Scientific Committee Co-Chair PLATFORM PRESENTATIONS Monday, 24 October 2016 09:00 – 09:32 Platform presentations 1: Fetal Diagnosis
1Department of Anaesthesiology and Intensive Care, Marmara University Medical School, Istanbul, T... more 1Department of Anaesthesiology and Intensive Care, Marmara University Medical School, Istanbul, Turkey 2Department of Anaesthesiology and Intensive Care, Health Sciences University Medical School, Derince Kocaeli, Turkey 3Department of Neurosurgery, Bilim University Medical School, Istanbul, Turkey 4Department of Obstetrics and Gynaecology, Health Sciences University Kanuni Sultan Suleyman SUAM, Istanbul, Turkey 5Department of Anaesthesiology and Intensive Care, Bilim University Medical School, Istanbul, Turkey
Objective: Myelomeningocele is the most severe and the most frequent form of spina bifida. Most o... more Objective: Myelomeningocele is the most severe and the most frequent form of spina bifida. Most of the myelomeningocele patients undergo operations in new-born age. In terms of life quality and rehabilitation, follow-up’s of these patients in the growth and development period after the operation is critical. In our study, our aim is to emphasize the correlation of SEP results with MRI results and clinical features of the myelomeningocele patients. Materials and Methods: In our study, we included 36 patients who had undergone myelomeningocele operation and have been followed-up in Istanbul Bilim University Florence Nightingale Hospital, Spina Bifida Research and Treatment Centre. Posterior tibial nerve SEP was performed on each patient and neurological examinations were done in the same session. Results were compared with clinical functional lesion levels, levels of fusion defect and ambulation levels. In order to evaluate SEP results, we used age-related reference values from Boor e...
Hidrosefali așiri miktarda beyin omurilik sivisinin dilate serebral ventrikuller ve subaraknoid b... more Hidrosefali așiri miktarda beyin omurilik sivisinin dilate serebral ventrikuller ve subaraknoid boslukta birikmesi ile seyreden bir bozukluktur. Bu olgularin yaklașik yarisinin myelomeningosel (spina bifida) ile ilișkili oldugu fakat bu oranin populasyonlar arasinda degisiklik gosterdigi bildirilmektedir. Hidrosefalideki bulgu ve semptomlar kafa ici basinc artiși ve ventrikullerdeki genislemeden kaynaklanmaktadir. Belirtiler non-spesifik ve etiyolojiden bagimsizdir. Hidrosefali vakalarinin cogu etkin ve kalici bir șekilde tedavi edilmedigi takdirde norolojik kotuleșme ile seyreder. En etkin tedavi șant veya ucuncu ventrikulostomi yolu ile cerrahi drenajdir. Bu yazida cocukluk cagi hidrosefalisini gozden gecirmeyi ladik.
Context: Spina bifida, hydrocephalus, and similar congenital central nervous system (CNS) anomali... more Context: Spina bifida, hydrocephalus, and similar congenital central nervous system (CNS) anomalies take origin from embryologic stages weeks before birth, but assessment and follow-up of these patients are important to figure and predict the effects of these anomalies on child’s neurodevelopment. Aims: To evaluate of multiple groups of congenital CNS anomalies in the neurodevelopment level. Settings and Design: The study was conducted at a research and treatment center for spina bifida patients. Materials and Methods: The study group included 348 patients with a mean age of 15.4 (±15.1) months, who had spina bifida aperta, hydrocephalus, and microcephaly. Patients with other known intracranial conditions were excluded. The subjects were evaluated into five groups: Group 1, 88 patients with congenital hydrocephalus; Group 2, 48 patients with congenital hydrocephalus and ventriculoperitoneal shunt; Group 3, 148 patients with microcephaly; Group 4, 30 patients who were operated for sp...
Deep brain stimulation (DBS) is a new alternative treatment for treatment-resistant major depress... more Deep brain stimulation (DBS) is a new alternative treatment for treatment-resistant major depression (MD) and obsessive-compulsive disorder (OCD). Various DBS targets were defined for MD and OCD. Nucleus accumbens (NAcc) comes out among the other targets in patients with MD and comorbid OCD when physiopathology and limited side effects are taken into account. We report a 27-year-old male with MD and OCD who was treated by bilateral NAcc-DBS. The aim of this study is to discuss NAcc as a DBS target in patients with MD and OCD and to report the first case of a psychiatric disorder treated with DBS in Turkey.
Bu calismanin amaci, lumbosakral etkilenimli Spina Bifidali olgularda alt ektremite kas kuvvetini... more Bu calismanin amaci, lumbosakral etkilenimli Spina Bifidali olgularda alt ektremite kas kuvvetinin, mobiliteye, fonksiyonel yurume duzeyine ve yasam kalitesine etkisinin arastirilmasidir. Calismaya 5- 18 yas araliginda lumbosakral etkilenimli Spina Bifida tanisi almis 40 olgu dahil edildi. Olgularin %60’i Meningomyelosel, %40’i Spina Bifida Okulta’dir. Katilimcilarin demografik verileri, vucut kitle indeksi, klinik bilgileri calismaci tarafindan hazirlanan forma kaydedildi. Alt ekstremite kas kuvveti olcumunde manuel kas testi yontemi kullanildi. Mobilite, Hoffer Siniflama Sistemi, yurume duzeyi Gillette Fonksiyonel Yurume Degerlendirme Skalasi ile ve yasam kalitesi Cocuklar Icin Yasam Kalitesi Anketi ile degerlendirildi. Analizlerde SPSS 22.0 programi kullanildi. Bagimsiz gruplarin birbirleri ile karsilastirilmasinda Student’s-t Independent ve Ki-Kare (Pearson Ki-Kare, Monte Carlo Ki-Kare) testleri kullanildi. Degiskenler arasindaki iliskinin analizi icin Sperman ve Pearson korelas...
The aim of this study was to investigate the dose dependent neuroprotective effect of recombinant... more The aim of this study was to investigate the dose dependent neuroprotective effect of recombinant human erythropoietin (r-Hu-EPO) in acute spinal cord injury induced rats. The rats were allocated into 4 groups of 8 rats each. Spinal cord injury was produced by Yaşargil aneurysm clip at a pressure of 0.7 N for a duration of 60 seconds. Group I (Controls) received laminectomy only. Group II (The trauma-only group) had no medication. In group III postoperative intraperitoneal (IP) EPO, total 2000 IU/kg, were applied in two doses. Group IV received postoperative IP EPO in 3 doses, total 9000 IU/kg. In all groups, neuromotor evaluation using Basso’s locomotor grading test was conducted at the 6th and 24th hours, and every day from the 1st to 15th days following surgery. After the fifteenth day, all rats were sacrificed and spinal cord samples were obtained for the assessment of caspase-3 activity. The results showed that caspase-3 activity increased to statistically significant higher le...
Miller blades are the most commonly used blades for direct laryngoscopy in paediatric anaesthesia... more Miller blades are the most commonly used blades for direct laryngoscopy in paediatric anaesthesia, including neonates. However, evidence that the Miller blade yields a superior view of the glottic opening compared with other blades is lacking [1, 2]. In a prospective, randomized study in infants and children, less than 2 years of age, the glottic views obtained with the Miller size 1 blade lifting the epiglottis and the Macintosh size 1 blade lifting the tongue base did not differ significantly [3]. In a second study, the glottic views and intubating conditions with the Miller and Macintosh size 1 blades in infants and children 1 month to 2 years of age were similar [4]. These data demonstrated equipoise for the glottic views with the Miller and Macintosh size 1 blades in infants and young children but shed no insight into their relative effectiveness to expose the glottic opening in neonates.
ABSTRACT Introduction: Myelomeningocele (MMC) is the most common cause of neurogenic bladder dysf... more ABSTRACT Introduction: Myelomeningocele (MMC) is the most common cause of neurogenic bladder dysfunction in children. Neurogenic bladder dysfunction is developed before birth due to autonomous nervous system affected prenatally in patients with MMC. The aim of this study was to share urodynamic study findings before MMC repair and to discuss the correlation with neurological evaluation. Materials and Methods: We prospectively studied 37 patients who underwent surgery for MMC repair in our institution in the first 20 h of their lives between 2013 and 2016. All patients were evaluated by a neurosurgeon, neonatologist, and pediatric surgeon. Urodynamic study was performed in first 18h of life before MMC repair in all patients. Lesion level, occurrence of hydrocephalus, neurological functions, spinal deformities, and urodynamic study results were analyzed. Results: The study included 18 female and 19 male patients. Overactive detrusor was detected in 22 patients, and hypoactive detrusor was detected in 5 patients. Overactive sphincter muscle was detected in 32 patients, and hypoactive sphincter was detected in 2 patients. Detrusor–sphincter dyssynergia was present in 34 patients. Conclusion: Detailed analysis of urodynamic study findings in larger patient groups may be important to understand the physiopathology of prenatal damage in patients with MMC.
Head and neck squamous cell carcinomas rarely cause cranial metastases, but HPV related subgroup ... more Head and neck squamous cell carcinomas rarely cause cranial metastases, but HPV related subgroup is known for unusual metastasis sites on the body. Despite the good overall treatment responses in this group, intracranial metastases are always accepted as a sign of rapid deterioration. We present a case of cranium metastasis of HPV related oropharyngeal squamous cell carcinoma, which had been very well responded to the treatment for years but deteriorates in a short period after the cranium metastasis.
Objective: Our aim of this study was to determine effective doses of progesterone which has a vas... more Objective: Our aim of this study was to determine effective doses of progesterone which has a vasodilatory effect during the early stage of vasospasm. Cerebral vasospasm (CV) is a predominant cause of morbidity and mortality which develops following subarachnoidal hemorrhage (SAH). Etiopathogenesis of CV is multifactorial. Despite many previously performed studies on this issue, the mechanism by which blood and blood products in the subarachnoidal space induce CV has not been clarified yet. Materials and Methods: In our study, we used “Rat Femoral Artery Vasospasm Model” introduced by Okada et al. Thanks to easy procurement and maintenance of rats. Rats were divided into four groups as: Group 1 (n = 8; control group), Group 2 (n = 8; vasospasm group), Group 3 (n = 8; vasospasm + 3 mg/kg progesterone group), and Group 4 (n = 8; vasospasm +15 mg/kg progesterone group). Progesterone which is an endogenously synthesized natural steroid was preferred in our study. Progesterone increases the production of vasodilatory epoxyeicosatrienoic acid by acting on its binding sites termed as pregnane X receptor. It decreases the intracellular influx of Ca2+ by blocking the functioning of L-type channels in smooth muscle cells. It manifests another vasodilatory effect by decreasing expression of TxA2 receptor. In our study, at the end of the 7th day, where the most intense vasospasm is seen, 1 cm pieces were excised from the femoral arteries and histopathologically examined under light microscope. Results: Vascular walls of three vasospasm-induced groups were relatively thicker when compared with the control group. Drug-treated groups were not different from each other. Vascular walls of the groups treated with lower and higher doses of the drug were thinner when compared with the vasospasm group without any statistically significant difference between groups (P > 0.05). Luminal cross-sectional areas of the drug-treated groups did not differ from each other. Mean luminal cross-sectional areas of the control and the drug-treated groups were larger than that of the vasospasm group without any statistically significant intergroup difference (P > 0.05). Conclusion: Based on the results of our study, progesterone did not exert protective effects on vascular wall thickness, while histopathological examination of luminal cross-sectional areas revealed its vasodilatory effects without any statistically significant difference between groups. Starting from the study results obtained, we think that its potential use as a preventive agent against the development of post-SAH CV requires conduction of multicentered, placebo-controlled, randomized, and double-blind studies.
IntroductionPediatric pituitary adenomas are rare lesions. Incidence is reported between 1 and 10... more IntroductionPediatric pituitary adenomas are rare lesions. Incidence is reported between 1 and 10% of all childhood brain tumors and between 3 and 6% of all surgically treated adenomas. Although pituitary adenomas present with symptoms of hormone hypersecretion or neurological disruptions secondary to mass effect, they are almost constantly benign. Characteristics of patients may vary in different studies according to age, gender, size of adenoma, hormonal activity, and recurrence rates.MethodsData on consecutive pediatric patients who were operated for pituitary adenoma with endoscopic endonasal transsphenoidal surgery (EETS) and transsphenoidal microsurgery (TMS) in the Department of Neurosurgery, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey, in the Neurosurgical Unit of the San Matteo Hospital, Pavia, Italy, and in the Division of Neurological Surgery Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy, between July 1997 and May 2018, were analyzed. Twenty-seven patients (11 males and 16 females), who were 18 years old or younger at the time of surgery, were included in the study. Medical records, images, and operative notes of patients were retrospectively reviewed.ResultsThere were 16 females (59.3%) and 11 males (40.7%). Mean age was 15.3 ± 3.3 (4–18). Thirty-two surgical procedures were performed for 27 patients (6 children required second operation). Thirteen patients (48.14%) had Cushing’s disease (CD), 5 patients (18.5%) had growth hormone (GH)-secreting adenoma, 5 patients (18.5%) had prolactinoma, and 4 patients (14.8%) had non-functional adenoma. Twenty-two patients (81.4%) met remission criteria, and 5 patients (18.5%) did not meet remission criteria. Four patients met remission criteria after the second operation.ConclusionTranssphenoidal approach affords effective release of mass effect and not only restoration but also perpetuation of normal endocrine functions in the majority of pediatric pituitary adenoma patients. Satisfactory results are reported with both EETS and TMS in the literature. Despite the technical difficulties in pediatric age, transsphenoidal resection of adenoma is still the mainstay treatment that provides cure in pediatric patients.
PurposeShunt placement indications are stringent and require confirmation of clinical and radiolo... more PurposeShunt placement indications are stringent and require confirmation of clinical and radiological evidence of hydrocephalus (HC). The aim of this study was to determine the rate of shunting and discuss the outcome in the first year of life in patients with myelomeningocele (MMC) on the basis of review of the literature.MethodsAll patients who underwent postnatal repair of MMC at our institution between March 2014 and March 2015 were evaluated. Patients were only included if they underwent both MMC repair and ventriculoperitoneal (VP) shunt insertion at our institution and were followed up for at least 12 months. The mean ages for repair of MMC, MMC levels, timing of VP shunt placement, shunt revisions, and causes of shunt revisions were documented.ResultsFifty-two patients with MMC were included in this study. The average gestational age at birth was 38 weeks. The level of MMC was thoracolumbar in 13 cases, 11 times lumbar, 21 times lumbosacral, and 7 times sacral. Thirty-one patients (59.61%) suffered from hydrocephalus and required placement of a shunt. When we evaluate the lesion levels of patients who require shunting, 13 cases were thoracolumbar, 6 cases were lumbar, and 11 cases were lumbosacral. None of the sacral cases needed VP shunt. Seven patients (13.4%) had shunt revision within the first year of life. The cause of shunt revision was wound problem in one patient (1.9%), underdrainage in two patients (3.8%), infection in three patients (5.7%), and mechanical obstruction in another one patient (1.9%).ConclusionMMC closure and management of the associated HC are one of the most basic, but never simple, legs of the pediatric neurosurgery around the world. As clinicians and neurosurgeons, we are obligated to analyze recent evidences and evaluate present approaches to achieve optimization in this subject until further technologies or approaches became more advantageous for our patients.
Objective: Willis polygon forms the basis of the arterial circulation of the cerebrum. Willis pol... more Objective: Willis polygon forms the basis of the arterial circulation of the cerebrum. Willis polygon is a vascular structure whom variations are not rare. Knowledge of the anatomy and preservation of its integrity is crucial for performing neurovascular surgery and intracranial tumour surgery. Because of the important vascular and neurological structures, approaches to this region are considered extremely risky. One of the main variations in-person basis is the diameter differences of the arteries, which forms Willis polygon, between the left and right hemispheres. About structure and variations, studies of Rhoton and Yasargil had formed the touchstone. Our aim is to contribute to the literature and clinical studies, to be done in the future, by comparing our results with previous studies about variations and morphometric features of Willis polygon. Methods: Arteries of 30 fresh cadaver brains were examined during autopsies in T.C. Ministry of Justice Istanbul Forensic Science Inst...
44th Annual Meeting of International Society for Pediatric Neurosurgery, Kobe, Japan, Oct 23-27, ... more 44th Annual Meeting of International Society for Pediatric Neurosurgery, Kobe, Japan, Oct 23-27, 2016 This supplement was not sponsored by outside commercial interests. It was funded entirely by the publisher. Graciela Zuccaro, ISPN President Mami Yamasaki, ISPN 2016 Annual Meeting Chair Graham Fieggen, ISPN 2016 Scientific Committee Chair Tony Figaji, ISPN 2016 Scientific Committee Co-Chair PLATFORM PRESENTATIONS Monday, 24 October 2016 09:00 – 09:32 Platform presentations 1: Fetal Diagnosis
1Department of Anaesthesiology and Intensive Care, Marmara University Medical School, Istanbul, T... more 1Department of Anaesthesiology and Intensive Care, Marmara University Medical School, Istanbul, Turkey 2Department of Anaesthesiology and Intensive Care, Health Sciences University Medical School, Derince Kocaeli, Turkey 3Department of Neurosurgery, Bilim University Medical School, Istanbul, Turkey 4Department of Obstetrics and Gynaecology, Health Sciences University Kanuni Sultan Suleyman SUAM, Istanbul, Turkey 5Department of Anaesthesiology and Intensive Care, Bilim University Medical School, Istanbul, Turkey
Objective: Myelomeningocele is the most severe and the most frequent form of spina bifida. Most o... more Objective: Myelomeningocele is the most severe and the most frequent form of spina bifida. Most of the myelomeningocele patients undergo operations in new-born age. In terms of life quality and rehabilitation, follow-up’s of these patients in the growth and development period after the operation is critical. In our study, our aim is to emphasize the correlation of SEP results with MRI results and clinical features of the myelomeningocele patients. Materials and Methods: In our study, we included 36 patients who had undergone myelomeningocele operation and have been followed-up in Istanbul Bilim University Florence Nightingale Hospital, Spina Bifida Research and Treatment Centre. Posterior tibial nerve SEP was performed on each patient and neurological examinations were done in the same session. Results were compared with clinical functional lesion levels, levels of fusion defect and ambulation levels. In order to evaluate SEP results, we used age-related reference values from Boor e...
Hidrosefali așiri miktarda beyin omurilik sivisinin dilate serebral ventrikuller ve subaraknoid b... more Hidrosefali așiri miktarda beyin omurilik sivisinin dilate serebral ventrikuller ve subaraknoid boslukta birikmesi ile seyreden bir bozukluktur. Bu olgularin yaklașik yarisinin myelomeningosel (spina bifida) ile ilișkili oldugu fakat bu oranin populasyonlar arasinda degisiklik gosterdigi bildirilmektedir. Hidrosefalideki bulgu ve semptomlar kafa ici basinc artiși ve ventrikullerdeki genislemeden kaynaklanmaktadir. Belirtiler non-spesifik ve etiyolojiden bagimsizdir. Hidrosefali vakalarinin cogu etkin ve kalici bir șekilde tedavi edilmedigi takdirde norolojik kotuleșme ile seyreder. En etkin tedavi șant veya ucuncu ventrikulostomi yolu ile cerrahi drenajdir. Bu yazida cocukluk cagi hidrosefalisini gozden gecirmeyi ladik.
Context: Spina bifida, hydrocephalus, and similar congenital central nervous system (CNS) anomali... more Context: Spina bifida, hydrocephalus, and similar congenital central nervous system (CNS) anomalies take origin from embryologic stages weeks before birth, but assessment and follow-up of these patients are important to figure and predict the effects of these anomalies on child’s neurodevelopment. Aims: To evaluate of multiple groups of congenital CNS anomalies in the neurodevelopment level. Settings and Design: The study was conducted at a research and treatment center for spina bifida patients. Materials and Methods: The study group included 348 patients with a mean age of 15.4 (±15.1) months, who had spina bifida aperta, hydrocephalus, and microcephaly. Patients with other known intracranial conditions were excluded. The subjects were evaluated into five groups: Group 1, 88 patients with congenital hydrocephalus; Group 2, 48 patients with congenital hydrocephalus and ventriculoperitoneal shunt; Group 3, 148 patients with microcephaly; Group 4, 30 patients who were operated for sp...
Deep brain stimulation (DBS) is a new alternative treatment for treatment-resistant major depress... more Deep brain stimulation (DBS) is a new alternative treatment for treatment-resistant major depression (MD) and obsessive-compulsive disorder (OCD). Various DBS targets were defined for MD and OCD. Nucleus accumbens (NAcc) comes out among the other targets in patients with MD and comorbid OCD when physiopathology and limited side effects are taken into account. We report a 27-year-old male with MD and OCD who was treated by bilateral NAcc-DBS. The aim of this study is to discuss NAcc as a DBS target in patients with MD and OCD and to report the first case of a psychiatric disorder treated with DBS in Turkey.
Bu calismanin amaci, lumbosakral etkilenimli Spina Bifidali olgularda alt ektremite kas kuvvetini... more Bu calismanin amaci, lumbosakral etkilenimli Spina Bifidali olgularda alt ektremite kas kuvvetinin, mobiliteye, fonksiyonel yurume duzeyine ve yasam kalitesine etkisinin arastirilmasidir. Calismaya 5- 18 yas araliginda lumbosakral etkilenimli Spina Bifida tanisi almis 40 olgu dahil edildi. Olgularin %60’i Meningomyelosel, %40’i Spina Bifida Okulta’dir. Katilimcilarin demografik verileri, vucut kitle indeksi, klinik bilgileri calismaci tarafindan hazirlanan forma kaydedildi. Alt ekstremite kas kuvveti olcumunde manuel kas testi yontemi kullanildi. Mobilite, Hoffer Siniflama Sistemi, yurume duzeyi Gillette Fonksiyonel Yurume Degerlendirme Skalasi ile ve yasam kalitesi Cocuklar Icin Yasam Kalitesi Anketi ile degerlendirildi. Analizlerde SPSS 22.0 programi kullanildi. Bagimsiz gruplarin birbirleri ile karsilastirilmasinda Student’s-t Independent ve Ki-Kare (Pearson Ki-Kare, Monte Carlo Ki-Kare) testleri kullanildi. Degiskenler arasindaki iliskinin analizi icin Sperman ve Pearson korelas...
The aim of this study was to investigate the dose dependent neuroprotective effect of recombinant... more The aim of this study was to investigate the dose dependent neuroprotective effect of recombinant human erythropoietin (r-Hu-EPO) in acute spinal cord injury induced rats. The rats were allocated into 4 groups of 8 rats each. Spinal cord injury was produced by Yaşargil aneurysm clip at a pressure of 0.7 N for a duration of 60 seconds. Group I (Controls) received laminectomy only. Group II (The trauma-only group) had no medication. In group III postoperative intraperitoneal (IP) EPO, total 2000 IU/kg, were applied in two doses. Group IV received postoperative IP EPO in 3 doses, total 9000 IU/kg. In all groups, neuromotor evaluation using Basso’s locomotor grading test was conducted at the 6th and 24th hours, and every day from the 1st to 15th days following surgery. After the fifteenth day, all rats were sacrificed and spinal cord samples were obtained for the assessment of caspase-3 activity. The results showed that caspase-3 activity increased to statistically significant higher le...
Miller blades are the most commonly used blades for direct laryngoscopy in paediatric anaesthesia... more Miller blades are the most commonly used blades for direct laryngoscopy in paediatric anaesthesia, including neonates. However, evidence that the Miller blade yields a superior view of the glottic opening compared with other blades is lacking [1, 2]. In a prospective, randomized study in infants and children, less than 2 years of age, the glottic views obtained with the Miller size 1 blade lifting the epiglottis and the Macintosh size 1 blade lifting the tongue base did not differ significantly [3]. In a second study, the glottic views and intubating conditions with the Miller and Macintosh size 1 blades in infants and children 1 month to 2 years of age were similar [4]. These data demonstrated equipoise for the glottic views with the Miller and Macintosh size 1 blades in infants and young children but shed no insight into their relative effectiveness to expose the glottic opening in neonates.
ABSTRACT Introduction: Myelomeningocele (MMC) is the most common cause of neurogenic bladder dysf... more ABSTRACT Introduction: Myelomeningocele (MMC) is the most common cause of neurogenic bladder dysfunction in children. Neurogenic bladder dysfunction is developed before birth due to autonomous nervous system affected prenatally in patients with MMC. The aim of this study was to share urodynamic study findings before MMC repair and to discuss the correlation with neurological evaluation. Materials and Methods: We prospectively studied 37 patients who underwent surgery for MMC repair in our institution in the first 20 h of their lives between 2013 and 2016. All patients were evaluated by a neurosurgeon, neonatologist, and pediatric surgeon. Urodynamic study was performed in first 18h of life before MMC repair in all patients. Lesion level, occurrence of hydrocephalus, neurological functions, spinal deformities, and urodynamic study results were analyzed. Results: The study included 18 female and 19 male patients. Overactive detrusor was detected in 22 patients, and hypoactive detrusor was detected in 5 patients. Overactive sphincter muscle was detected in 32 patients, and hypoactive sphincter was detected in 2 patients. Detrusor–sphincter dyssynergia was present in 34 patients. Conclusion: Detailed analysis of urodynamic study findings in larger patient groups may be important to understand the physiopathology of prenatal damage in patients with MMC.
Head and neck squamous cell carcinomas rarely cause cranial metastases, but HPV related subgroup ... more Head and neck squamous cell carcinomas rarely cause cranial metastases, but HPV related subgroup is known for unusual metastasis sites on the body. Despite the good overall treatment responses in this group, intracranial metastases are always accepted as a sign of rapid deterioration. We present a case of cranium metastasis of HPV related oropharyngeal squamous cell carcinoma, which had been very well responded to the treatment for years but deteriorates in a short period after the cranium metastasis.
Objective: Our aim of this study was to determine effective doses of progesterone which has a vas... more Objective: Our aim of this study was to determine effective doses of progesterone which has a vasodilatory effect during the early stage of vasospasm. Cerebral vasospasm (CV) is a predominant cause of morbidity and mortality which develops following subarachnoidal hemorrhage (SAH). Etiopathogenesis of CV is multifactorial. Despite many previously performed studies on this issue, the mechanism by which blood and blood products in the subarachnoidal space induce CV has not been clarified yet. Materials and Methods: In our study, we used “Rat Femoral Artery Vasospasm Model” introduced by Okada et al. Thanks to easy procurement and maintenance of rats. Rats were divided into four groups as: Group 1 (n = 8; control group), Group 2 (n = 8; vasospasm group), Group 3 (n = 8; vasospasm + 3 mg/kg progesterone group), and Group 4 (n = 8; vasospasm +15 mg/kg progesterone group). Progesterone which is an endogenously synthesized natural steroid was preferred in our study. Progesterone increases the production of vasodilatory epoxyeicosatrienoic acid by acting on its binding sites termed as pregnane X receptor. It decreases the intracellular influx of Ca2+ by blocking the functioning of L-type channels in smooth muscle cells. It manifests another vasodilatory effect by decreasing expression of TxA2 receptor. In our study, at the end of the 7th day, where the most intense vasospasm is seen, 1 cm pieces were excised from the femoral arteries and histopathologically examined under light microscope. Results: Vascular walls of three vasospasm-induced groups were relatively thicker when compared with the control group. Drug-treated groups were not different from each other. Vascular walls of the groups treated with lower and higher doses of the drug were thinner when compared with the vasospasm group without any statistically significant difference between groups (P > 0.05). Luminal cross-sectional areas of the drug-treated groups did not differ from each other. Mean luminal cross-sectional areas of the control and the drug-treated groups were larger than that of the vasospasm group without any statistically significant intergroup difference (P > 0.05). Conclusion: Based on the results of our study, progesterone did not exert protective effects on vascular wall thickness, while histopathological examination of luminal cross-sectional areas revealed its vasodilatory effects without any statistically significant difference between groups. Starting from the study results obtained, we think that its potential use as a preventive agent against the development of post-SAH CV requires conduction of multicentered, placebo-controlled, randomized, and double-blind studies.
IntroductionPediatric pituitary adenomas are rare lesions. Incidence is reported between 1 and 10... more IntroductionPediatric pituitary adenomas are rare lesions. Incidence is reported between 1 and 10% of all childhood brain tumors and between 3 and 6% of all surgically treated adenomas. Although pituitary adenomas present with symptoms of hormone hypersecretion or neurological disruptions secondary to mass effect, they are almost constantly benign. Characteristics of patients may vary in different studies according to age, gender, size of adenoma, hormonal activity, and recurrence rates.MethodsData on consecutive pediatric patients who were operated for pituitary adenoma with endoscopic endonasal transsphenoidal surgery (EETS) and transsphenoidal microsurgery (TMS) in the Department of Neurosurgery, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey, in the Neurosurgical Unit of the San Matteo Hospital, Pavia, Italy, and in the Division of Neurological Surgery Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy, between July 1997 and May 2018, were analyzed. Twenty-seven patients (11 males and 16 females), who were 18 years old or younger at the time of surgery, were included in the study. Medical records, images, and operative notes of patients were retrospectively reviewed.ResultsThere were 16 females (59.3%) and 11 males (40.7%). Mean age was 15.3 ± 3.3 (4–18). Thirty-two surgical procedures were performed for 27 patients (6 children required second operation). Thirteen patients (48.14%) had Cushing’s disease (CD), 5 patients (18.5%) had growth hormone (GH)-secreting adenoma, 5 patients (18.5%) had prolactinoma, and 4 patients (14.8%) had non-functional adenoma. Twenty-two patients (81.4%) met remission criteria, and 5 patients (18.5%) did not meet remission criteria. Four patients met remission criteria after the second operation.ConclusionTranssphenoidal approach affords effective release of mass effect and not only restoration but also perpetuation of normal endocrine functions in the majority of pediatric pituitary adenoma patients. Satisfactory results are reported with both EETS and TMS in the literature. Despite the technical difficulties in pediatric age, transsphenoidal resection of adenoma is still the mainstay treatment that provides cure in pediatric patients.
PurposeShunt placement indications are stringent and require confirmation of clinical and radiolo... more PurposeShunt placement indications are stringent and require confirmation of clinical and radiological evidence of hydrocephalus (HC). The aim of this study was to determine the rate of shunting and discuss the outcome in the first year of life in patients with myelomeningocele (MMC) on the basis of review of the literature.MethodsAll patients who underwent postnatal repair of MMC at our institution between March 2014 and March 2015 were evaluated. Patients were only included if they underwent both MMC repair and ventriculoperitoneal (VP) shunt insertion at our institution and were followed up for at least 12 months. The mean ages for repair of MMC, MMC levels, timing of VP shunt placement, shunt revisions, and causes of shunt revisions were documented.ResultsFifty-two patients with MMC were included in this study. The average gestational age at birth was 38 weeks. The level of MMC was thoracolumbar in 13 cases, 11 times lumbar, 21 times lumbosacral, and 7 times sacral. Thirty-one patients (59.61%) suffered from hydrocephalus and required placement of a shunt. When we evaluate the lesion levels of patients who require shunting, 13 cases were thoracolumbar, 6 cases were lumbar, and 11 cases were lumbosacral. None of the sacral cases needed VP shunt. Seven patients (13.4%) had shunt revision within the first year of life. The cause of shunt revision was wound problem in one patient (1.9%), underdrainage in two patients (3.8%), infection in three patients (5.7%), and mechanical obstruction in another one patient (1.9%).ConclusionMMC closure and management of the associated HC are one of the most basic, but never simple, legs of the pediatric neurosurgery around the world. As clinicians and neurosurgeons, we are obligated to analyze recent evidences and evaluate present approaches to achieve optimization in this subject until further technologies or approaches became more advantageous for our patients.
Objective: Willis polygon forms the basis of the arterial circulation of the cerebrum. Willis pol... more Objective: Willis polygon forms the basis of the arterial circulation of the cerebrum. Willis polygon is a vascular structure whom variations are not rare. Knowledge of the anatomy and preservation of its integrity is crucial for performing neurovascular surgery and intracranial tumour surgery. Because of the important vascular and neurological structures, approaches to this region are considered extremely risky. One of the main variations in-person basis is the diameter differences of the arteries, which forms Willis polygon, between the left and right hemispheres. About structure and variations, studies of Rhoton and Yasargil had formed the touchstone. Our aim is to contribute to the literature and clinical studies, to be done in the future, by comparing our results with previous studies about variations and morphometric features of Willis polygon. Methods: Arteries of 30 fresh cadaver brains were examined during autopsies in T.C. Ministry of Justice Istanbul Forensic Science Inst...
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