Spinal meningiomas are benign, well-circumscribed and slowly growing intradural tumors that compr... more Spinal meningiomas are benign, well-circumscribed and slowly growing intradural tumors that compress the spinal cord. Hereby, a retrospective review of 61 spinal meningioma cases evaluated in terms of demographic, clinical, pathological and radiological features to predict the early postoperative functional outcomes. Patients' records and MRI images of all the histologically confirmed spinal meningioma cases that underwent surgical resection at two university hospitals from January 2005 to June 2016 were retrospectively reviewed. Demographic data, clinical findings, radiological features and pathology reports were reviewed. Univariate and multivariate logistic regression analyses were used to evaluate the impact of each factor on the early 3-month post-surgical functional outcome. A receiver operating characteristic (ROC) curve was used to predict the power of the model. 61 cases of spinal meningiomas were operated. 13 males (21%) and 48 females (79%). Mean age 60.5 years old ranging (24-92). Patients presented with back pain (57%), motor deficits (47.5%), sensory deficits (18%) and sphincteric dysfunction (11.5%). One case (1.6%) showed an additional extradural growth. 40 thoracic, 9 cervical, 5 cervicothoracic, 5 thoracolumbar and 2 lumbar cases. Only 4 cases (6.6%) showed atypical pathological features (WHO grade II). At 3-month follow up, 46 patients (75.4%) had either functionally improved or remained stable. 15 patients (24.6%) had "worse" functional outcome. Three variables showed statistically significant odds ratio for improved outcomes (OR): presurgical motor deficit (OR =5; p=0.005); pre - surgical sensory disturbance (OR=3.5; p=0.026); pre-surgical myelopathy (OR=3.5; P=0.026). Multivariate analysis showed increased OR for cross sectional ratio, pre-surgical myelopathy, pre-surgical radiculopathy and non - cervical location of tumor (1.59, 3.46, 3.2, 1.63/3.56 respectively). Although none has reached statistical significance (p>0.05), the receiver operating characteristic (ROC) curve showed an Area Under the Curve (AUC) of (0.74). The independent predictors of the early postoperative functional outcomes of spinal meningioma resections may include pre-surgical motor deficit, sensory deficit and myelopathy.
BACKGROUND Modafinil has been proven to exert anti-inflammatory, anti-oxidative and neuroprotecti... more BACKGROUND Modafinil has been proven to exert anti-inflammatory, anti-oxidative and neuroprotective effects on numerous neurological disorders. However, its effects after traumatic brain injury (TBI) has not been yet explore. This study aimed to explore if Modafinil can attenuate the neuroinflammatory phase of TBI and clarify the possible underlying mechanisms. METHODS A weight drop model was used to induce experimental TBI on 30 Wistar albino rats. The treatment group received Modafinil on the day of the trauma and the following 5 days. Garcia Test was used to assess for neurological status and histopathological examination along with biochemical analysis of NSE, S-100B, CASP3, and TBARS levels were performed. RESULTS Rats treated with Modafinil after the trauma had a statistically significant higher Garcia test score (p<0.001) and presented with increased evidence of anti-inflammatory and neuroprotective effect (p<0.05, p=0.005). Decreased levels of all biochemical parameters with NSE, CASP3, and TBARS having statistical significance was observed (p<0.05). CONCLUSIONS The findings of this paper support the notion that a psychoactive drug Modafinil, traditionally used for sleep disorders and also known as a cognitive enhancer may prove beneficial in decreasing mortality and morbidity after TBI through anti-inflammatory, anti-oxidative and neuroprotective effects.
Foraminal lumbar root schwannoma A 55-year-old man with a past medical history of livingdonor ren... more Foraminal lumbar root schwannoma A 55-year-old man with a past medical history of livingdonor renal transplant 10 years ago presented with chronic right radicular pain along the course of the right L5 nerve for several months duration. In his neurologic examination, he had sensorial disturbance along the right L5 dermatome. Plain radiographs of the lumbar spine showed enlargement of the right neural foramen without bone destruction (Fig. 1). Magnetic resonance imaging revealed a soft tissue mass in the right L4-L5 neural foramen causing neural foraminal widening and bone remodeling. The mass was heterogeneously hyperintense on T2-weighted image, hypointense to intervertebral disk on T1-weighted image, and showed intense homogeneous enhancement on postcontrast image (Figs. 2 and 3). The transplanted kidney was also seen on the right iliac fossa. The tumor was totally removed through a right L5 laminectomy and right-sided foraminotomy with instrumentation (Fig. 4). Histopathologic diagnosis was benign schwannoma. The patient was discharged without any motor deficit.
BACKGROUND AND IMPORTANCE Symptomatic lumbar disc herniation is common. Migration of a free disc ... more BACKGROUND AND IMPORTANCE Symptomatic lumbar disc herniation is common. Migration of a free disc fragment is usually found in rostral, caudal, or lateral directions. Posterior epidural migration is very rare. We report the first case with posterior epidural migration and sequestration into bilateral facet joints of a free disc fragment. CLINICAL PRESENTATION A 78-year-old female presented with low back pain and right leg pain. Plain radiographs showed lumbar spondylolisthesis. Magnetic resonance imaging revealed a posterior epidural mass and intrafacet mass, which was hypointense on T1-weighted images and hyperintense on T2-weighted images. The lesion in the left L3-4 facet joint had rim enhancement, whereas the right one was not contrasted after gadolinium injection. Preoperative differential diagnosis included abscess, tumor, hematoma, or synovial cyst. An interbody cage fusion at L3-4 and L4-5 for spondylolisthesis was performed, and a hybrid technique was applied with the Dynesy...
Objective: The aim of this study to present the results of surgical outcome of the patients who w... more Objective: The aim of this study to present the results of surgical outcome of the patients who were operated with transpedicular posterior screw fixation and posterolateral fusion for lumbar spondylolysthesis. Methods: In this study, we evaluated 32 patients who were treated for ...
Glioma and meningioma are two common primary brain tumors in the adult population. Although menin... more Glioma and meningioma are two common primary brain tumors in the adult population. Although meningioma and glioblastoma represent two common intracranial neoplasms’, the concurrent development of these tumors in same patient is extremely rare [1–4]. The simultaneous occurrence of meningioma and glioblastoma multiforme was described in the literature in about 60 cases. In most of these cases, two distinct intracranial tumors developed in the same patient after cranial radiotherapy. Phacomatosis was also found to be associated with this simultaneous occurrence in a significant number of the cases described. We report a patient with concurrent glioblastoma multiforme and meningioma in the same anatomical region without a history of radiotherapy or phacomatoses.
Spinal meningiomas are benign, well-circumscribed and slowly growing intradural tumors that compr... more Spinal meningiomas are benign, well-circumscribed and slowly growing intradural tumors that compress the spinal cord. Hereby, a retrospective review of 61 spinal meningioma cases evaluated in terms of demographic, clinical, pathological and radiological features to predict the early postoperative functional outcomes. Patients&amp;amp;amp;amp;amp;amp;#39; records and MRI images of all the histologically confirmed spinal meningioma cases that underwent surgical resection at two university hospitals from January 2005 to June 2016 were retrospectively reviewed. Demographic data, clinical findings, radiological features and pathology reports were reviewed. Univariate and multivariate logistic regression analyses were used to evaluate the impact of each factor on the early 3-month post-surgical functional outcome. A receiver operating characteristic (ROC) curve was used to predict the power of the model. 61 cases of spinal meningiomas were operated. 13 males (21%) and 48 females (79%). Mean age 60.5 years old ranging (24-92). Patients presented with back pain (57%), motor deficits (47.5%), sensory deficits (18%) and sphincteric dysfunction (11.5%). One case (1.6%) showed an additional extradural growth. 40 thoracic, 9 cervical, 5 cervicothoracic, 5 thoracolumbar and 2 lumbar cases. Only 4 cases (6.6%) showed atypical pathological features (WHO grade II). At 3-month follow up, 46 patients (75.4%) had either functionally improved or remained stable. 15 patients (24.6%) had &amp;amp;amp;amp;amp;amp;quot;worse&amp;amp;amp;amp;amp;amp;quot; functional outcome. Three variables showed statistically significant odds ratio for improved outcomes (OR): presurgical motor deficit (OR =5; p=0.005); pre - surgical sensory disturbance (OR=3.5; p=0.026); pre-surgical myelopathy (OR=3.5; P=0.026). Multivariate analysis showed increased OR for cross sectional ratio, pre-surgical myelopathy, pre-surgical radiculopathy and non - cervical location of tumor (1.59, 3.46, 3.2, 1.63/3.56 respectively). Although none has reached statistical significance (p&amp;amp;amp;amp;amp;amp;gt;0.05), the receiver operating characteristic (ROC) curve showed an Area Under the Curve (AUC) of (0.74). The independent predictors of the early postoperative functional outcomes of spinal meningioma resections may include pre-surgical motor deficit, sensory deficit and myelopathy.
BACKGROUND Modafinil has been proven to exert anti-inflammatory, anti-oxidative and neuroprotecti... more BACKGROUND Modafinil has been proven to exert anti-inflammatory, anti-oxidative and neuroprotective effects on numerous neurological disorders. However, its effects after traumatic brain injury (TBI) has not been yet explore. This study aimed to explore if Modafinil can attenuate the neuroinflammatory phase of TBI and clarify the possible underlying mechanisms. METHODS A weight drop model was used to induce experimental TBI on 30 Wistar albino rats. The treatment group received Modafinil on the day of the trauma and the following 5 days. Garcia Test was used to assess for neurological status and histopathological examination along with biochemical analysis of NSE, S-100B, CASP3, and TBARS levels were performed. RESULTS Rats treated with Modafinil after the trauma had a statistically significant higher Garcia test score (p<0.001) and presented with increased evidence of anti-inflammatory and neuroprotective effect (p<0.05, p=0.005). Decreased levels of all biochemical parameters with NSE, CASP3, and TBARS having statistical significance was observed (p<0.05). CONCLUSIONS The findings of this paper support the notion that a psychoactive drug Modafinil, traditionally used for sleep disorders and also known as a cognitive enhancer may prove beneficial in decreasing mortality and morbidity after TBI through anti-inflammatory, anti-oxidative and neuroprotective effects.
Foraminal lumbar root schwannoma A 55-year-old man with a past medical history of livingdonor ren... more Foraminal lumbar root schwannoma A 55-year-old man with a past medical history of livingdonor renal transplant 10 years ago presented with chronic right radicular pain along the course of the right L5 nerve for several months duration. In his neurologic examination, he had sensorial disturbance along the right L5 dermatome. Plain radiographs of the lumbar spine showed enlargement of the right neural foramen without bone destruction (Fig. 1). Magnetic resonance imaging revealed a soft tissue mass in the right L4-L5 neural foramen causing neural foraminal widening and bone remodeling. The mass was heterogeneously hyperintense on T2-weighted image, hypointense to intervertebral disk on T1-weighted image, and showed intense homogeneous enhancement on postcontrast image (Figs. 2 and 3). The transplanted kidney was also seen on the right iliac fossa. The tumor was totally removed through a right L5 laminectomy and right-sided foraminotomy with instrumentation (Fig. 4). Histopathologic diagnosis was benign schwannoma. The patient was discharged without any motor deficit.
BACKGROUND AND IMPORTANCE Symptomatic lumbar disc herniation is common. Migration of a free disc ... more BACKGROUND AND IMPORTANCE Symptomatic lumbar disc herniation is common. Migration of a free disc fragment is usually found in rostral, caudal, or lateral directions. Posterior epidural migration is very rare. We report the first case with posterior epidural migration and sequestration into bilateral facet joints of a free disc fragment. CLINICAL PRESENTATION A 78-year-old female presented with low back pain and right leg pain. Plain radiographs showed lumbar spondylolisthesis. Magnetic resonance imaging revealed a posterior epidural mass and intrafacet mass, which was hypointense on T1-weighted images and hyperintense on T2-weighted images. The lesion in the left L3-4 facet joint had rim enhancement, whereas the right one was not contrasted after gadolinium injection. Preoperative differential diagnosis included abscess, tumor, hematoma, or synovial cyst. An interbody cage fusion at L3-4 and L4-5 for spondylolisthesis was performed, and a hybrid technique was applied with the Dynesy...
Objective: The aim of this study to present the results of surgical outcome of the patients who w... more Objective: The aim of this study to present the results of surgical outcome of the patients who were operated with transpedicular posterior screw fixation and posterolateral fusion for lumbar spondylolysthesis. Methods: In this study, we evaluated 32 patients who were treated for ...
Glioma and meningioma are two common primary brain tumors in the adult population. Although menin... more Glioma and meningioma are two common primary brain tumors in the adult population. Although meningioma and glioblastoma represent two common intracranial neoplasms’, the concurrent development of these tumors in same patient is extremely rare [1–4]. The simultaneous occurrence of meningioma and glioblastoma multiforme was described in the literature in about 60 cases. In most of these cases, two distinct intracranial tumors developed in the same patient after cranial radiotherapy. Phacomatosis was also found to be associated with this simultaneous occurrence in a significant number of the cases described. We report a patient with concurrent glioblastoma multiforme and meningioma in the same anatomical region without a history of radiotherapy or phacomatoses.
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Papers by Umit Kepoglu