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Elmesallamy WAEA. The role of intraoperative ultrasound in gross total resection of brain mass lesions and outcome. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2019. [DOI: 10.1186/s41983-019-0117-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Surgical resection of brain mass lesion mandates safety and the best outcome for the patient.
Objectives
The aim of this study was the evaluation of intraoperative ultrasound (IOUS) in gross total resection of brain mass lesions and patients’ safety in comparison to conventional surgery.
Materials and methods
In total, 632 patients were operated for brain mass lesion resection at Neurosurgery Department, Zagazig University Hospitals, during the period from January 2011 to October 2018 and divided randomly into two groups, IOUS group and conventional group, for the detection value of IOUS in resection, safety, and outcome after 3 months follow-up.
Results
The IOUS group showed statistically significant gross total resection regardless to pathology, location, size, age, and sex in favor of IOUS use, and also, there were significantly less complications and better outcome after 3 months follow-up with the IOUS group. Significantly better outcome was found with gross total resection in total surgeries.
Conclusions
The use of IOUS during brain mass lesion surgery is safe and can assist the surgeon in gross total resection with better outcome.
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Elmesallamy WAEA. Demonstrative study of brain anatomical landmarks by intraoperative ultrasound imaging. EGYPTIAN JOURNAL OF NEUROSURGERY 2019. [DOI: 10.1186/s41984-019-0056-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Objectives
Intraoperative use of ultrasound in brain surgery needs good understanding of the brain anatomy in ultrasound images. This study aims to compare ultrasound imaging of brain anatomical landmarks during surgery to perioperative computed tomography (CT), and perioperative magnetic resonance imaging (MRI) as demonstration for encouraging usage as low cost, available and hazardless device.
Methods
In total; 350 patients were subjected to brain surgeries under ultrasound guidance using 2.5–8 megahertz (MHZ) transducers, at neurosurgery department Zagazig university hospital from January 2012 to January 2019. Brain anatomical landmarks were compared between ultrasound images, and perioperative images for safe, and confident surgeries.
Results
Various intracranial anatomical landmarks could be well-demonstrated by ultrasound through the open fontanel, or once the skull was opened, and during surgical work in real time fashion, facilitating surgical procedures, and avoiding complications.
Conclusion
Real-time ultrasound is of great help during brain surgeries in delineating brain anatomical landmarks as well as MRI, and CT brain. The growing learning standard of intraoperative ultrasound (IOUS) use makes brain surgery more simple with avoiding brain shift problems, radiation exposure, and high cost of other intraoperative modalities.
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Xiao SY, Zhang J, Zhu ZQ, Li YP, Zhong WY, Chen JB, Pan ZY, Xia HC. Application of fluorescein sodium in breast cancer brain-metastasis surgery. Cancer Manag Res 2018; 10:4325-4331. [PMID: 30349366 PMCID: PMC6190807 DOI: 10.2147/cmar.s176504] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective Surgical resection serves an important role in the multidisciplinary treatment of cerebral metastases (CMs). Conventional white-light, microsurgical, and circumferential stripping of CMs is standard neurosurgical procedure, but is associated with a high recurrence rate. Based on this outcome, there is an urgent need for a new surgical strategy, such as fluorescence-guided resection, for CMs, in order to achieve total removal. Methods A retrospective study was carried out in 38 patients clinically and pathologically diagnosed with breast cancer brain metastasis at three medical centers from May 2012 to June 2016. The study comprised group 1 (fluorescein-guided surgery) and group 2 (standard microsurgery). In group 1, 5 mg/kg of fluorescein sodium was injected intravenously after an allergy test and before general anesthesia for 17 patients. A yellow 560 filter was employed for microsurgical tumor resection. Group 2 consisted of 21 patients for whom fluorescein was not administered. Results Surgical outcomes were assessed concerning the extent of resection and Karnofsky performance status. Gross total resection was achieved in these patients, with high fluorescence markedly enhancing tumor visibility. The extent of resection had a powerful influence on performance status. Overall survival after CM was 24.1 months in patients given fluorescein and was 22.8 months in the nonfluorescein group. Conclusion Fluorescein-guided surgery is a simple, safe, and practical method to resect breast cancer brain metastasis, and leads to a higher proportion of resection compared to common microsurgery. This offers a tremendous advantage when navigating a tiny tumor, and improves the quality of life of patients with CM.
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Affiliation(s)
- Shi-Yin Xiao
- Department of Neurosurgery, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China,
| | - Ji Zhang
- Department of Neurosurgery, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Zheng-Quan Zhu
- Department of Neurosurgery, Tumor Hospital Affiliated of Xinjiang Medical University, Xinshi District, Urumqi, Xinjiang 830011, China
| | - You-Ping Li
- Department of Neurosurgery, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330046, China
| | - Wei-Ying Zhong
- Department of Neurosurgery, Qilu Hospital, Shandong University, Jinan 250012, China
| | - Jian-Bin Chen
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhen-Yu Pan
- Department of Radiation-Oncology, First Hospital of Jilin University, Changchun 130021, China
| | - Hai-Chen Xia
- Department of Neurosurgery, Tumor Hospital Affiliated of Xinjiang Medical University, Xinshi District, Urumqi, Xinjiang 830011, China
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Miller D, Carney P, Archer JS, Fitt GJ, Jackson GD, Bulluss KJ. Intraoperative definition of bottom-of-sulcus dysplasia using intraoperative ultrasound and single depth electrode recording - A technical note. J Clin Neurosci 2017; 48:191-195. [PMID: 29137921 DOI: 10.1016/j.jocn.2017.10.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/04/2017] [Accepted: 10/10/2017] [Indexed: 10/18/2022]
Abstract
Bottom of sulcus dysplasias (BOSDs) are localized focal cortical dysplasias (FCDs) centred on the bottom of a sulcus that can be highly epileptogenic, but difficult to delineate intraoperatively. We report on a patient with refractory epilepsy due to a BOSD, successfully resected with the aid of a multimodal surgical approach using neuronavigation based on MRI and PET, intraoperative ultrasound (iUS) and electrocorticography (ECoG) using depth electrodes. The lesion could be visualized on iUS showing an increase in echogenicity at the grey-white matter junction. IUS demonstrated the position of the depth electrode in relation to the lesion. Depth electrode recording showed almost continuous spiking. Thus, intraoperative imaging and electrophysiology helped confirm the exact location of the lesion. Post-resection ultrasound demonstrated the extent of the resection and depth electrode recording did not show any epileptiform activity. Thus, both techniques helped assess completeness of resection. The patient has been seizure free since surgery. Using a multimodal approach including iUS and ECoG is a helpful adjunct in surgery for BOSD and may improve seizure outcome.
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Affiliation(s)
- Dorothea Miller
- Department of Neurosurgery, Austin Health, Heidelberg, Victoria, Australia; Department of Neurosurgery, Essen University Hospital, Essen, Nordrhein-Westfalen, Germany.
| | - Patrick Carney
- Department of Neurology, Austin Health, Heidelberg, Victoria, Australia; Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Box Hill, Victoria, Australia; The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, Victoria, Australia
| | - John S Archer
- Department of Neurology, Austin Health, Heidelberg, Victoria, Australia; University of Melbourne, Austin Health, Heidelberg, Victoria, Australia; The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, Victoria, Australia
| | - Gregory J Fitt
- Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
| | - Graeme D Jackson
- Department of Neurology, Austin Health, Heidelberg, Victoria, Australia; The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, Victoria, Australia
| | - Kristian J Bulluss
- Department of Neurosurgery, Austin Health, Heidelberg, Victoria, Australia
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Perin A, Prada FU, Moraldo M, Schiappacasse A, Galbiati TF, Gambatesa E, d’Orio P, Riker NI, Basso C, Santoro M, Meling TR, Schaller K, DiMeco F. USim: A New Device and App for Case-Specific, Intraoperative Ultrasound Simulation and Rehearsal in Neurosurgery. A Preliminary Study. Oper Neurosurg (Hagerstown) 2017; 14:572-578. [DOI: 10.1093/ons/opx144] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 05/19/2017] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Intraoperative ultrasound (iUS) is an excellent aid for neurosurgeons to perform better and safer operations thanks to real time, continuous, and high-quality intraoperative visualization.
OBJECTIVE
To develop an innovative training method to teach how to perform iUS in neurosurgery.
METHODS
Patients undergoing surgery for different brain or spine lesions were iUS scanned (before opening the dura) in order to arrange a collection of 3-dimensional, US images; this set of data was matched and paired to preoperatively acquired magnetic resonance images in order to create a library of neurosurgical cases to be studied offline for training and rehearsal purposes. This new iUS training approach was preliminarily tested on 14 European neurosurgery residents, who participated at the 2016 European Association of Neurosurgical Societies Training Course (Sofia, Bulgaria).
RESULTS
USim was developed by Camelot and the Besta NeuroSim Center as a dedicated app that transforms any smartphone into a “virtual US probe,” in order to simulate iUS applied to neurosurgery on a series of anonymized, patient-specific cases of different central nervous system tumors (eg, gliomas, metastases, meningiomas) for education, simulation, and rehearsal purposes. USim proved to be easy to use and allowed residents to quickly learn to handle a US probe and interpret iUS semiotics.
CONCLUSION
USim could help neurosurgeons learn neurosurgical iUS safely. Furthermore, neurosurgeons could simulate many cases, of different brain/spinal cord tumors, that resemble the specific cases they have to operate on. Finally, the library of cases would be continuously updated, upgraded, and made available to neurosurgeons.
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Affiliation(s)
- Alessandro Perin
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Nazionale “C. Besta,” Milan, Italy
| | - Francesco Ugo Prada
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Nazionale “C. Besta,” Milan, Italy
| | | | | | | | - Enrico Gambatesa
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Nazionale “C. Besta,” Milan, Italy
| | - Piergiorgio d’Orio
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Nazionale “C. Besta,” Milan, Italy
| | - Nicole Irene Riker
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Nazionale “C. Besta,” Milan, Italy
| | | | | | | | - Karl Schaller
- Neurosurg-ery Department, Hopitaux Universitaires de Genève, Geneva, Switzerland
| | - Francesco DiMeco
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Nazionale “C. Besta,” Milan, Italy
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Alvarado E, Leach J, Caré M, Mangano F, O Hara S. Pediatric Spinal Ultrasound: Neonatal and Intraoperative Applications. Semin Ultrasound CT MR 2017; 38:126-142. [PMID: 28347416 DOI: 10.1053/j.sult.2016.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this article is to review the use of ultrasound as a screening tool for spinal diseases in neonates and infants and its intraoperative value in selected pediatric neurosurgical disorders. A review of spinal embryology followed by a description of common spinal diseases in neonates assessed with ultrasound is presented. Indications for spinal ultrasound in neonates, commonly identified conditions, and the importance of magnetic resonance imaging in selected cases are emphasized. Additionally, the use of ultrasound in selected neurosurgical spinal diseases in pediatric patients is presented with magnetic resonance imaging and intraoperative correlation. Technique, limitations, and pitfalls are discussed.
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Affiliation(s)
- Enrique Alvarado
- Department of Radiology, Cincinnati Children׳s Hospital Medical Center, Cincinnati, OH
| | - James Leach
- Department of Radiology, Cincinnati Children׳s Hospital Medical Center, Cincinnati, OH.
| | - Marguerite Caré
- Department of Radiology, Cincinnati Children׳s Hospital Medical Center, Cincinnati, OH
| | - Francesco Mangano
- Department of Neurosurgery, Cincinnati Children׳s Hospital Medical Center, Cincinnati, OH
| | - Sara O Hara
- Department of Radiology, Cincinnati Children׳s Hospital Medical Center, Cincinnati, OH
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Smith H, Taplin A, Syed S, Adamo MA. Correlation between intraoperative ultrasound and postoperative MRI in pediatric tumor surgery. J Neurosurg Pediatr 2016; 18:578-584. [PMID: 27472668 DOI: 10.3171/2016.5.peds15739] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Malignant disease of the CNS is the primary etiology for deaths resulting from cancer in the pediatric population. It has been well documented that outcomes of pediatric neurosurgery rely on the extent of tumor resection. Therefore, techniques that improve surgical results have significant clinical implications. Intraoperative ultrasound (IOUS) offers real-time surgical guidance and a more accurate means for detecting residual tumor that is inconspicuous to the naked eye. The objective of this study was to evaluate the correlation of extent of resection between IOUS and postoperative MRI. The authors measured the correlation of extent of resection, negative predictive value, and sensitivity of IOUS and compared them with those of MRI. METHODS This study consisted of a retrospective review of the medical charts of all pediatric patients who underwent neurosurgical treatment of a tumor between August 2009 and July 2015 at Albany Medical Center. Included were patients who were aged ≤ 21 years, who underwent brain or spinal tumor resection, for whom IOUS was used during the tumor resection, and for whom postoperative MRI (with and without contrast) was performed within 1 week of surgery. RESULTS Sixty-two patients met inclusion criteria for the study (33 males, mean age 10.0 years). The IOUS results very significantly correlated with postoperative MRI results (φ = 0.726; p = 0.000000011; negative predictive value 86.3% [95% CI 73.7%-94.3%]). These results exemplify a 71% overall gross-total resection rate and 80% intended gross-total resection rate with the use of IOUS (i.e., excluding cases performed only for debulking purposes). CONCLUSIONS The use of IOUS may play an important role in achieving a greater extent of resection by providing real-time information on tumor volume and location in the setting of brain shift throughout the course of an operation. The authors support the use of IOUS in pediatric CNS tumor surgery to improve clinical outcomes at low cost with minimal additional operating-room time and no identified additional risk.
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Affiliation(s)
- Heather Smith
- Department of Neurosurgery, Albany Medical Center, Albany, New York
| | - AmiLyn Taplin
- Department of Neurosurgery, Albany Medical Center, Albany, New York
| | - Sohail Syed
- Department of Neurosurgery, Albany Medical Center, Albany, New York
| | - Matthew A Adamo
- Department of Neurosurgery, Albany Medical Center, Albany, New York
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Mursch K, Scholz M, Brück W, Behnke-Mursch J. The value of intraoperative ultrasonography during the resection of relapsed irradiated malignant gliomas in the brain. Ultrasonography 2016; 36:60-65. [PMID: 27776402 PMCID: PMC5207359 DOI: 10.14366/usg.16015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 08/07/2016] [Accepted: 08/08/2016] [Indexed: 12/03/2022] Open
Abstract
Purpose The aim of this study was to investigate whether intraoperative ultrasonography (IOUS) helped the surgeon navigate towards the tumor as seen in preoperative magnetic resonance imaging and whether IOUS was able to distinguish between tumor margins and the surrounding tissue. Methods Twenty-five patients suffering from high-grade gliomas who were previously treated by surgery and radiotherapy were included. Intraoperatively, two histopathologic samples were obtained a sample of unequivocal tumor tissue (according to anatomical landmarks and the surgeon’s visual and tactile impressions) and a small tissue sample obtained using a navigated needle when the surgeon decided to stop the resection. This specimen was considered to be a boundary specimen, where no tumor tissue was apparent. The decision to take the second sample was not influenced by IOUS. The effect of IOUS was analyzed semi-quantitatively. Results All 25 samples of unequivocal tumor tissue were histopathologically classified as tumor tissue and were hyperechoic on IOUS. Of the boundary specimens, eight were hypoechoic. Only one harbored tumor tissue (P=0.150). Seventeen boundaries were moderately hyperechoic, and these samples contained all possible histological results (i.e., tumor, infiltration, or no tumor). Conclusion During surgery performed on relapsed, irradiated, high-grade gliomas, IOUS provided a reliable method of navigating towards the core of the tumor. At borders, it did not reliably distinguish between remnants or tumor-free tissue, but hypoechoic areas seldom contained tumor tissue.
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Affiliation(s)
- Kay Mursch
- Department of Neurosurgery, Zentralklinik, Bad Berka, Germany
| | - Martin Scholz
- Department of Neurosurgery, Klinikum Duisburg, Duisburg, Germany
| | - Wolfgang Brück
- Department of Neuropathology, Georg August Universität, Göttingen, Germany
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Schebesch KM, Hoehne J, Hohenberger C, Acerbi F, Broggi M, Proescholdt M, Wendl C, Riemenschneider MJ, Brawanski A. Fluorescein sodium-guided surgery in cerebral lymphoma. Clin Neurol Neurosurg 2015; 139:125-8. [PMID: 26432995 DOI: 10.1016/j.clineuro.2015.09.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/20/2015] [Accepted: 09/22/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Growth and progress of primary central nervous lymphoma (PCNSL) severely disrupt the blood brain barrier (BBB). Such disruptions can be intraoperatively visualized by injecting fluorescein sodium (FL) and applying a YELLOW 560 nm surgical microscope filter. Here, we report a small cohort of patients with PCNSL that mimicked high grade gliomas (HGG) or cerebral metastases (CM), who had been operated on with the use of FL. PATIENTS AND METHODS Retrospectively, seven patients with PCNSL were identified, who had been operated on by means of microsurgery after intravenous FL injection. The surgical reports were screened for statements on the grade of fluorescent staining in the tumor area. One representative case was chosen to show the staining under white light as well as under filtered light at different distances to the tumor area. RESULTS All patients had shown bright and homogenous fluorescent staining of the tumor (n=7. 100%). No adverse effects had been observed. CONCLUSION Similar to patients with HGG or CM, patients with PCNSL may benefit from use of FL and the dedicated YELLOW 560 nm filter in open surgery.
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Affiliation(s)
- Karl-Michael Schebesch
- Department of Neurosurgery, Regensburg University Hospital, Germany; Wilhelm-Sander Neuro-Oncology Unit, Regensburg University Hospital, Germany.
| | - Julius Hoehne
- Department of Neurosurgery, Regensburg University Hospital, Germany; Wilhelm-Sander Neuro-Oncology Unit, Regensburg University Hospital, Germany
| | - Christoph Hohenberger
- Department of Neurosurgery, Regensburg University Hospital, Germany; Wilhelm-Sander Neuro-Oncology Unit, Regensburg University Hospital, Germany
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Martin Proescholdt
- Department of Neurosurgery, Regensburg University Hospital, Germany; Wilhelm-Sander Neuro-Oncology Unit, Regensburg University Hospital, Germany
| | - Christina Wendl
- Institute of Radiology, Neuroradiology Branch, Regensburg University Hospital, Germany; Wilhelm-Sander Neuro-Oncology Unit, Regensburg University Hospital, Germany
| | - Markus J Riemenschneider
- Department of Neuropathology, Regensburg University Hospital, Germany; Wilhelm-Sander Neuro-Oncology Unit, Regensburg University Hospital, Germany
| | - Alexander Brawanski
- Department of Neurosurgery, Regensburg University Hospital, Germany; Wilhelm-Sander Neuro-Oncology Unit, Regensburg University Hospital, Germany
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Kazanci A, Gurcan O, Gurcay A, Bozkurt I, Algin O, Turkoglu O, Bavbek M. A simple, safe and effective surface marking and targeting method combined with intraoperative ultrasonography for small subcortical intracranial lesions. J Neurosurg Sci 2015; 63:270-279. [PMID: 26173480 DOI: 10.23736/s0390-5616.16.03336-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Accurately locating small subcortical brain lesions is very important for maximal surgical resection with minimal neurological damage. Intraoperative MRI has proved to be more precise than ultrasound, it is relatively expensive and is not available in all centers. Herein we describe a new, simple, safe and effective method for determining a small skin incision and craniotomy via skin staples combined with intraoperative ultrasonography to determine the margins, vascularity and residue of the lesion. METHODS Thirty-three patients with small subcortical lesions were admitted into the study. The maximum diameter of the lesions ranged between 18 and 30 mm. The depth of the lesion was described as the distance between the cortical surface and most outer point of the lesion. The mean of the depth of the lesions was 10.56 mm ranging between 3.3 and 18.7 mm. Multiple skin staples were used as irremovable skin markers. Before and after dural incision, ultrasound was used to assess the lesion size and location, its relationship with the surrounding tissue and the Doppler function to reveal the blood supply to the lesion. RESULTS In this study mean craniotomy diameter was 44 mm ranging between 32-55 mm. The location, extent, characteristics and adjacent tissue of the lesion were observed by high frequency ultrasonography during the operation. CONCLUSIONS We describe a simple, safe and effective method for determining a small skin incision and craniotomy combined with intraoperative ultrasound for small subcortical intracranial lesions for health center that does not have intraoperative MRI and navigation systems.
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Affiliation(s)
- Atilla Kazanci
- Department of Neurosurgery, Ankara Ataturk Research and Training Hospital, Ankara, Turkey -
| | - Oktay Gurcan
- Department of Neurosurgery, Ankara Ataturk Research and Training Hospital, Ankara, Turkey
| | - Ahmet Gurcay
- Department of Neurosurgery, Ankara Ataturk Research and Training Hospital, Ankara, Turkey
| | - Ismail Bozkurt
- Department of Neurosurgery, Ankara Ataturk Research and Training Hospital, Ankara, Turkey
| | - Oktay Algin
- Department of Radiology, Ankara Ataturk Research and Training Hospital, Ankara, Turkey
| | - Omer Turkoglu
- Department of Neurosurgery, Ankara Ataturk Research and Training Hospital, Ankara, Turkey
| | - Murad Bavbek
- Department of Neurosurgery, School of Medicine, Yildirim Beyazit University, Ankara, Turkey
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