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Gulsever CI, Öztürk M, Sahin D, Koksoy F, Ornek V, Aydoseli A, Sencer A. Full-Endoscopic Surgery for Hypothalamic Hamartoma Resection. J Vis Exp 2024. [PMID: 38682937 DOI: 10.3791/64705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024] Open
Abstract
Hypothalamic hamartomas (HH) are rare developmental anomalies of the inferior hypothalamus that often cause refractory epilepsy, including gelastic seizures. Surgical resection is an effective method to treat drug-resistant epilepsy and endocrinopathy in a suitable patient group. Open surgery, endoscopic surgery, ablative procedures, and stereotactic radiosurgery can be utilized. In this study, we aimed to describe the full-endoscopic approach for HH resection. The technique involves the use of an intraoperative ultrasonography (USG) system, a 30° rigid endoscope system that has an outside diameter of 2.7 mm with two working channels, a stylet that has an outer diameter of 3.8 mm, a monopolar coagulation electrode, a fiberoptic light guide, and the endovision system. Microforceps and monopolar electrocautery are the two main surgical instruments for HH removal. The protocol is easy to apply after a particular learning curve has been passed and shorter than open surgical approaches. It leads to less blood loss. Full-endoscopic surgery for HH is a minimally invasive technique that can be applied safely and effectively with good seizure and endocrinological outcomes. It provides low surgical site pain and early mobilization.
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Affiliation(s)
| | - Metehan Öztürk
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University
| | - Duran Sahin
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University
| | - Fatih Koksoy
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University
| | - Veysel Ornek
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University
| | - Aydin Aydoseli
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University
| | - Altay Sencer
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University
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Dolas I, Unal TC, Yorukoglu AG, Ruetten S, Dolen D, Gulsever CI, Sahin D, Aydoseli A, Sencer A. Full-Endoscopic Technique for Posterior Fossa Decompression in Chiari Malformation. Oper Neurosurg (Hagerstown) 2023; 25:e345-e351. [PMID: 37820101 DOI: 10.1227/ons.0000000000000875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/14/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND AND IMPORTANCE Full-endoscopic techniques are well-described for spinal procedures. Although endoscopic-assisted techniques are reported for posterior fossa decompression (PFD) in Chiari malformation (CM), a full-endoscopic technique is yet to be reported in these patients. The aim of this study was to present and describe a full-endoscopic technique for PFD in patients with CM. CLINICAL PRESENTATION Two patients diagnosed with CM were operated on by the full-endoscopic PFD technique. The patients consented to the procedure and to the publication of their image. An endoscope with an oval shaft cross-section with a diameter of 9.3 mm, a working length of 177 mm, a viewing angle of 20°, and a working channel of 5.6 diameters were used. Operative videos were recorded. The surgical steps were easily applied after the clear anatomic landmarks, such as the C1 posterior tubercle and the rectus capitis posterior minor muscles. The patients were followed up for 6 months. Both patients were symptom-free with a significant decrease in Visual Analog Scale score and a good functional outcome assessed by Chicago Chiari Outcome Scale after surgery without any complications. CONCLUSION All the steps of the full-endoscopic technique for PFD described by the authors in their previous human cadaveric study were also feasible on patients with CM.
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Affiliation(s)
- Ilyas Dolas
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Tugrul Cem Unal
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ali Guven Yorukoglu
- Department of Neurosurgery, Istanbul Scoliosis and Spine Center, Florence Nightingale Hospital, Istanbul, Turkey
| | - Sebastian Ruetten
- Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St. Elisabeth Group-Catholic Hospitals Rhein-Ruhr, St. Anna Hospital Herne/Marien Hospital Herne University Hospital/Marien Hospital Witten, Herne, Germany
| | - Duygu Dolen
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Cafer Ikbal Gulsever
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Duran Sahin
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Aydin Aydoseli
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Altay Sencer
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Dolgun M, Dölen D, Uyur Yalçın E, Dolaş İ, Ünal TC, Şirin NG, Sakarya Güneş A, Bebek N, Aydoseli A, Gürses C, Kara B, Sencer A. Effectiveness and Safety of Epilepsy Surgery for Pediatric Patients with Intractable Epilepsy: A Clinical Retrospective Study from a Single-Center Experience. Pediatr Neurosurg 2023; 59:1-13. [PMID: 37926092 DOI: 10.1159/000535023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Pediatric epilepsy surgery is an effective treatment modality for patients with drug-resistant epilepsy (DRE). Early pediatric surgery yields favorable results for DRE in terms of seizure control and neurophysiological outcome. In this study, pediatric patients were categorized based on their age (above 3 years old and below 3 years old) to demonstrate the effectiveness and safety of surgical procedures. METHODS In this retrospective, single-center study, 60 pediatric patients who underwent epilepsy surgery at Istanbul Faculty of Medicine between 2002 and 2018 were evaluated. Overall morbidity and mortality rates, as well as seizure outcomes of the patients, were assessed and compared based on two age groups: those aged 3 years old or younger and those older than 3 years old. The effectiveness of invasive monitoring was also evaluated in relation to pathological results. The postoperative seizure outcome rates were evaluated using Engel's classification, with an average follow-up period of 8.7 years. RESULTS Out of the total number of patients, 47 (78.4%) underwent resective surgery, while 13 (21.6%) had palliative surgery. Ten patients (16.6%) had invasive monitoring. Among all patients, 34 were classified as Engel I and II (56.6%), while 26 were classified as Engel III and IV (43.4%) postoperatively. 47% of patients who were under 3 years old, 60.4% of patients who were over 3 years old, and 50% of patients who underwent invasive monitoring had a favorable seizure outcome (Engel I-II). Postoperative morbidity and mortality rates were 35% (n = 21) and 1.6% (n = 1), respectively. CONCLUSION Pediatric epilepsy surgery is an important treatment modality for preserving cognitive abilities and providing effective treatment for pediatric DRE. In our study, we claim that both invasive monitoring and epilepsy surgery lead to favorable seizure outcomes for all age groups. Further clinical studies should be conducted to provide more reliable data on the safety and effectiveness of the surgery, particularly in patients under the age of three.
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Affiliation(s)
- Müge Dolgun
- Department of Neurosurgery, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Duygu Dölen
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Emek Uyur Yalçın
- Department of Pediatric Neurology, Zeynep Kamil Maternity and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - İlyas Dolaş
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Tuğrul Cem Ünal
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Nermin Görkem Şirin
- Department of Neurology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ayfer Sakarya Güneş
- Division of Child Neurology, Department of Pediatrics, University of Kocaeli, Faculty of Medicine, Izmit, Turkey
| | - Nerses Bebek
- Department of Neurology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Aydın Aydoseli
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Candan Gürses
- Department of Neurology, Koc University, Istanbul, Turkey
| | - Bülent Kara
- Division of Child Neurology, Department of Pediatrics, University of Kocaeli, Faculty of Medicine, Izmit, Turkey
| | - Altay Sencer
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Unal TC, Dolas I, Sahin D, Gulsever CI, Dolen D, Aras Y, Aydoseli A, Sabanci PA, Sencer A. Intraoperative ultrasound-guided ventricular cannulation in patients with normal-sized ventricles. Neurochirurgie 2023; 69:101463. [PMID: 37393990 DOI: 10.1016/j.neuchi.2023.101463] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/05/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Many pathologies require normal-sized ventricle cannulation, which may be technically challenging even with neuronavigation guidance. This study presents a series of ventricular cannulation of normal-sized ventricles using intraoperative ultrasound (iUS) guidance and the outcomes of patients treated by this technique, for the first time. METHODS The study included patients who underwent ultrasound-guided ventricular cannulation of normal-sized ventricles (either ventriculoperitoneal (VP) shunting or Ommaya reservoir) between January 2020 and June 2022. All patients underwent iUS-guided ventricular cannulation from the right Kocher's point. The inclusion criteria for normal-sized ventricles were as follows: (1) Evans index <30%, and (2) widest third ventricle diameter <6mm. Medical records and pre-, intra- and post-operative imaging were retrospectively analyzed. RESULTS Nine of the 18 included patients underwent VP shunt placement; 6 had idiopathic intracranial hypertension (IIH), 2 had resistant cerebrospinal fluid fistula following posterior fossa surgery, and 1 had iatrogenic intracranial pressure elevation following foramen magnum decompression. Nine patients underwent Ommaya reservoir implantation, 6 of whom had breast carcinoma and leptomeningeal metastases and 3 hematologic disease and leptomeningeal infiltration. All catheter tip positions were achieved in a single attempt, and none were placed suboptimally. Mean follow-up was 10 months. One IIH patient (5.5%) had early shunt infection which necessitated shunt removal. CONCLUSION iUS is a simple and safe method for accurate cannulation of normal-sized ventricles. It provides an effective real-time guidance option for challenging punctures.
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Affiliation(s)
- T C Unal
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul Tip Fakultesi, Nörolojik Bilimler Binasi, Fatih/Istanbul 34093, Turkey.
| | - I Dolas
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul Tip Fakultesi, Nörolojik Bilimler Binasi, Fatih/Istanbul 34093, Turkey
| | - D Sahin
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul Tip Fakultesi, Nörolojik Bilimler Binasi, Fatih/Istanbul 34093, Turkey
| | - C I Gulsever
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul Tip Fakultesi, Nörolojik Bilimler Binasi, Fatih/Istanbul 34093, Turkey
| | - D Dolen
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul Tip Fakultesi, Nörolojik Bilimler Binasi, Fatih/Istanbul 34093, Turkey
| | - Y Aras
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul Tip Fakultesi, Nörolojik Bilimler Binasi, Fatih/Istanbul 34093, Turkey
| | - A Aydoseli
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul Tip Fakultesi, Nörolojik Bilimler Binasi, Fatih/Istanbul 34093, Turkey
| | - P A Sabanci
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul Tip Fakultesi, Nörolojik Bilimler Binasi, Fatih/Istanbul 34093, Turkey
| | - A Sencer
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul Tip Fakultesi, Nörolojik Bilimler Binasi, Fatih/Istanbul 34093, Turkey
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Unal TC, Sencer A, Dolas I, Gulsever CI, Sahin D, Dolen D, Ozata MS, Ozturk M, Aras Y, Aydoseli A. Corrigendum: Full-endoscopic removal of third ventricular colloid cysts: technique, results, and limitations. Front Surg 2023; 10:1234433. [PMID: 37425346 PMCID: PMC10327886 DOI: 10.3389/fsurg.2023.1234433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 06/13/2023] [Indexed: 07/11/2023] Open
Abstract
[This corrects the article DOI: 10.3389/FSURG.2023.1174144.].
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Unal TC, Sencer A, Dolas I, Gulsever CI, Sahin D, Dolen D, Ozata MS, Ozturk M, Aras Y, Aydoseli A. Full-endoscopic removal of third ventricular colloid cysts: technique, results, and limitations. Front Surg 2023; 10:1174144. [PMID: 37334201 PMCID: PMC10272465 DOI: 10.3389/fsurg.2023.1174144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/24/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Colloid cysts (CCs) are rare benign lesions that usually arise from the roof of the third ventricle. They may present with obstructive hydrocephalus and cause sudden death. Treatment options include ventriculoperitoneal shunting, cyst aspiration, and cyst resection microscopically or endoscopically. This study aims to report and discuss the full-endoscopic technique for removing colloid cysts. Materials and methods A 25°-angled neuroendoscope with an internal working channel diameter of 3.1 mm and a length of 122 mm is used. The authors described the technique of resecting a colloid cyst by a full-endoscopic procedure and evaluated the surgical, clinical, and radiological results. Results Twenty-one consecutive patients underwent an operation with a transfrontal full-endoscopic approach. The swiveling technique (grasping the cyst wall and rotational movements) was used for CC resection. Of these patients, 11 were female, and ten were male (mean age, 41 years). The most frequent initial symptom was a headache. The mean cyst diameter was 13.9 mm. Thirteen patients had hydrocephalus at admission, and one needed shunting after cyst resection. Seventeen patients (81%) underwent total resection; 3 (14%), subtotal resection; and 1 (5%), partial resection. There was no mortality; one patient had permanent hemiplegia, and one had meningitis. The mean follow-up period was 14 months. Conclusion Even though microscopic resection of cysts has been widely used as a gold standard, successful endoscopic removal has been described recently with lower complication rates. Applying angled endoscopy with different techniques is essential for total resection. Our study is the first case series to show the outcomes of the swiveling technique with low recurrence and complication rates.
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Yildiz MZ, Peker B, Unal TC, Dolas I, Gulsever CI, Dolen D, Sonmez E, Aras Y, Aydoseli A, Sabanci PA, Sencer A, Izgi AN. The effect of halofuginone use on epidural fibrosis after spinal surgery: An animal experiment. Turk Neurosurg 2023. [PMID: 38650558 DOI: 10.5137/1019-5149.jtn.42998-22.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
AIM Epidural fibrosis (EF) can cause persistent low back pain after spinal surgery. Type I collagen is the main component of scar tissue formed after spinal surgery, and an antifibrotic agent is necessary for preventing fibrosis. Halofuginone is an antifibrotic agent that has an effect on type I collagen. Our study aimed to investigate the effectiveness of local halofuginone application for spinal EF after lumbar laminectomy in rats. MATERIAL AND METHODS Forty rats were equally divided into four groups (Groups I-IV; 10 rats in each group), and lumbar laminectomy was performed under general anesthesia. After laminectomy, Group I received saline (NaCl 0.9%) locally (control), Group II received spongostan, Group III received 0.5 mL of halofuginone-impregnated spongostan, and Group IV received 0.5 mL of halofuginone. Spongostan was used to prolong the exposure period of halofuginone. All rats were sacrificed after four weeks and evaluated according to histopathological criteria. A p-value of 0.05 was considered statistically significant. RESULTS Fibrosis was significantly lower in Group IV than in Group I (p 0.05). There was no significant difference in fibrosis between Group II/III and Group I. It was observed that spongostan increased fibrosis. CONCLUSION Halofuginone helps prevent EF after spinal surgery. However, further clinical and experimental studies are needed to assess its safety in humans.
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Affiliation(s)
- Mehmet Zeki Yildiz
- Bahcesehir University, Pendik Medical Park Hospital, Department of Neurosurgery, Istanbul, Türkiye
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Dolas I, Yorukoglu AG, Sencer A, Unal TC, Gulsever CI, Aydoseli A, Aras Y, Sabanci PA, Ruetten S. Full-endoscopic technique for posterior fossa decompression in Chiari malformation type I: An anatomical feasibility study in human cadavers. Clin Anat 2023; 36:660-668. [PMID: 36786563 DOI: 10.1002/ca.24024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 01/30/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023]
Abstract
Although endoscope-assisted techniques have been described, a full-endoscopic approach is yet to be performed for posterior fossa decompression (PFD) in Chiari malformation type I (CM-I). This study aims to describe the full-endoscopic PFD technique and evaluate its feasibility. Five fresh-frozen anonymized adult human cadavers were operated on using an endoscope with an oval shaft cross-section with a diameter of 9.3 mm, a working length of 177 mm, and a viewing angle of 20°. It also had an eccentric working channel with a diameter of 5.6 mm, a light guide, a sheath for continuous irrigation, and a rod lens system. The instruments were introduced from the working channel. Posterior craniocervical structures were dissected, and PFD was achieved. The planned steps were performed in all five cadavers. The endoscope was introduced to the posterior craniocervical region, dissecting the structures to easily expose the suboccipital bone and C1 posterior arch. Important structures, such as the C1 posterior tubercle, rectus capitis posterior minor muscles, and posterior atlantooccipital membrane, were used as landmarks. PFD was feasible even with the dural opening. Using the full-endoscopic approach, posterior craniocervical structures can be reached, and PFD can be performed successfully. The instruments used are well-defined for spinal usage; thus, this full-endoscopic technique can be widely used in the surgical treatment of patients with CM-I.
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Affiliation(s)
- I Dolas
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - A G Yorukoglu
- Department of Neurosurgery, Istanbul Scoliosis and Spine Center, Florence Nightingale Hospital, Istanbul, Turkey
| | - A Sencer
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tugrul Cem Unal
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - C I Gulsever
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - A Aydoseli
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Y Aras
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - P A Sabanci
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - S Ruetten
- Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St. Elisabeth Group-Catholic Hospitals Rhein-Ruhr, St. Anna Hospital Herne/Marien Hospital Herne University Hospital/Marien Hospital Witten, Herne, Germany
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Dolas I, Unal TC, Gulsever CI, Sahin D, Huseynov H, Barburoglu M, Ozturk O, Can H, Adiyaman AE, Dagdeviren HE, Sabanci PA, Aydoseli A, Aras Y, Sencer A, Sencer S. Endovascular treatment of posterior circulation aneurysms: Results from a single-team experience of 81 cases including 13 flow diversion treatment. Neurocirugia (Astur : Engl Ed) 2023:S2529-8496(22)00097-1. [PMID: 36774258 DOI: 10.1016/j.neucie.2022.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/29/2022] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Relatively constant surgical risks and rapid advances in endovascular treatment have caused a major shift toward endovascular management of posterior circulation aneurysms. This paper presents the results of a series of endovascularly treated posterior circulation aneurysms. METHODS A total of 81 patients who underwent endovascular treatment of posterior circulation aneurysms performed by a single team between 2009 and 2019 were included. Demographic, clinical, radiologic, and management details were retrospectively obtained from hospital records. RESULTS Among the included patients, 50 (61.7%) and 31 (38.3%) were female and male, respectively. Subarachnoid hemorrhage was observed in 30 patients (37%). Moreover, 40 (49.3%) aneurysms were treated with stent-assisted coiling, 1 (1.2%) aneurysm was treated with parent artery occlusion, 2 (2.4%) aneurysms were coiled using balloon assistance, 24 (29.6%) aneurysms were coiled primarily, 1 (1.2%) patient had an unsuccessful treatment attempt, and 13 (16.0%) aneurysms were treated with flow-diverter stents or stent monotherapy. During the last follow-up, 57 (83.8%) aneurysms were completely occluded, whereas 6 (8.8%) and 2 (2.9%) aneurysms did and did not have a residual neck, respectively. Flow diversion was used to treat 13 patients, among whom 8 had total occlusion or stable residue. A total of 7 deaths (8.6%) were encountered in this series. CONCLUSION Endovascular treatment should be considered as the primary treatment modality for posterior circulation aneurysms. Despite the high morbidity and mortality rates, promising results can be achieved with correct patient selection. Flow diversion can be a feasible alternative for complex aneurysms that are difficult to treat.
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Affiliation(s)
- Ilyas Dolas
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Tugrul Cem Unal
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Cafer Ikbal Gulsever
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
| | - Duran Sahin
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Heydar Huseynov
- Department of Radiology, Istanbul Atlas University, Istanbul, Turkey
| | - Mehmet Barburoglu
- Department of Radiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Onur Ozturk
- Department of Neurosurgery, Istanbul Bilim University, Istanbul, Turkey
| | - Halil Can
- Department of Neurosurgery, Istanbul Atlas University, Istanbul, Turkey
| | - Ali Ekrem Adiyaman
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Huseyin Emre Dagdeviren
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Pulat Akin Sabanci
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Aydin Aydoseli
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Yavuz Aras
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Altay Sencer
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Serra Sencer
- Department of Radiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Aras Y, Dolas I, Dolen D, Unal TC, Sahin D, Gulsever CI, Sabanci PA, Sencer A. Pediatric Cerebral Cavernous Malformation: A Single-Centered Experience of 23 Cases. Turk Neurosurg 2023; 33:63-69. [PMID: 36924006 DOI: 10.5137/1019-5149.jtn.36915-21.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIM To describe, and to evaluate the clinical and radiological characteristics of pediatric cavernous malformations (CMs) and the surgical approaches and their outcomes in a single center. MATERIAL AND METHODS We retrospectively reviewed pediatric patients with CMs that were treated in our center between 2010 and 2020. Radiological, clinical, and demographic features, as well as treatment details were evaluated. RESULTS Of 23 patients, 12 were male, and 11 were female. Two patients with multiple CMs had a family history. The most common symptoms were headaches (9/23, 39.1%) and seizures (9/23, 39.1%). Twenty patients had single lesions and three patients had multiple lesions. According to Zabramski classification, eight (34.7%) patients had type 1, 11 (47.8%) had type 2 and four (17.3%) had type 3 lesions. Thirteen patients had recurrent preoperative hemorrhages and nine had increased lesion size. Seven patients (30.4%) had coexisting deep venous anomalies in the CM vicinity. Twenty-one patients underwent microsurgical resection (5/23 simple lesionectomy, 16/23 lesionectomy + resection of the surrounding hemosiderin ring). All lesions were completely resected. No surgical mortalities or major complications occurred. CONCLUSION Since pediatric CMs are more aggressive than adult CMs, they should not be underestimated. Microsurgical total resection should be the first treatment choice where possible. We concluded that early surgical treatment and resection of perilesional hemosiderin-stained tissue, when feasible, yield the most favorable results at long-term follow-up including seizure outcomes.
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Affiliation(s)
- Yavuz Aras
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurosurgery, Istanbul, Turkey
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11
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Kapar O, Gurkan ZM, Dolgun M, Sencer A, Gürses C, Bilgic B. Focal cortical dysplasia pathology: diagnostic difficulty, classification, and utility for pathogenesis. Neurosurg Focus 2022; 53:E6. [DOI: 10.3171/2022.7.focus21731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 07/21/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE
In the histopathological examination of treatment-resistant epilepsy, focal cortical dysplasia (FCD) is the most common diagnosis in the pediatric group. FCD is classified histopathologically according to the International League Against Epilepsy (ILAE) classification. In the last decade since the ILAE classification has been released, molecular genetic studies have revealed mTOR pathway–related mutations as a major etiology. The objective of this study was to determine the incidence of FCD in treatment-resistant epilepsy patients, explore histomorphological and immunohistochemical features, examine clinicopathological correlation, demonstrate mTOR pathway activation using a pS6 antibody immunohistochemically, and try to introduce a candidate for possible targeted therapies.
METHODS
Paraffin blocks and slides of tissue from patients with treatment-resistant epilepsy were reexamined retrospectively. Histopathological subtypes of FCD were determined according to the ILAE classification. NeuN and neurofilament H (NF-H) staining were performed, and additionally a pS6 antibody was used to demonstrate mTOR pathway activation.
RESULTS
In 32 cases diagnosed with FCD, or 17.5% of 183 surgical epilepsy materials, there were no significant differences in the statistical analysis of clinical variables between the ILAE FCD subtypes. Recommended antibody NeuN revealed microcolumnar alignment in the FCD type Ia and IIIa groups and the loss of lamination in the type Ib group. Another recommended antibody, NF-H, was not found to be useful in discriminating between normal and dysmorphic neurons. pS6 expression, showing mTOR pathway activation, was observed in dysmorphic neurons and balloon cells in all FCD type II cases.
CONCLUSIONS
Significant pS6 expression in FCD type II represents the genomic nature of the disease noted in the literature. Nevertheless, the known MTOR gene and mTOR pathway–related mutations remain behind proportionally to explain the mTOR pathway activation in all FCD type II cases. Clinicopathologically and genetically integrated classification and usage of mTOR pathway inhibitors in treatment are expected as a recent evolution.
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Affiliation(s)
- Ozge Kapar
- Department of Pathology, Istanbul University
| | - Zahide Mail Gurkan
- Department of Neurology and Clinical Neurophysiology, Istanbul University
| | - Muge Dolgun
- Department of Neurosurgery, Sultangazi Haseki Training and Research Hospital
| | - Altay Sencer
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University; and
| | - Candan Gürses
- Department of Neurology, Koc University, Istanbul, Turkey
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12
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Dolas I, Unal TC, Gulsever CI, Sahin D, Huseynov H, Barburoglu M, Ozturk O, Can H, Adiyaman AE, Dagdeviren HE, Sabanci PA, Aydoseli A, Aras Y, Sencer A, Sencer S. Endovascular treatment of posterior circulation aneurysms: Results from a single-team experience of 81 cases including 13 flow diversion treatment. Neurocirugia (Astur) 2022. [DOI: 10.1016/j.neucir.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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13
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Güçlü DG, Öztürk O, Çırak M, Can H, Ünal TC, Dolaş İ, Özgen U, Aydoseli A, Sencer A. A series of post-traumatic midline epidural hematoma and review of the literature. ULUS TRAVMA ACIL CER 2022; 28:805-811. [PMID: 35652865 PMCID: PMC10443009 DOI: 10.14744/tjtes.2020.28182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 12/24/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Supratentorial midline epidural hematoma is rare but challenging in diagnosis and management. Indication for surgery can arise even following hospital admission. Being familiar to the presentation and watching out for direct and indirect signs on axial computed tomography (CT) such as suture diastasis or fracture traversing midline are essential to plan multi-planar CT enabling exact diagnosis including form and mass effect of hematoma. METHODS Nine patients with midline epidural hematoma including two pediatric patients underwent surgery between 2013 and 2018. Pre-operative and post-operative patient status, radiological features, and surgical technique were analyzed. RESULTS Four patients had deteriorating consciousness levels and two patients had paraparesis. All had fractures traversing midline and epidural hematomas with significant mass effect. They were operated through separated craniotomies around the midline and midline bone strip was used for dural tenting and as support for natural closure of bone flaps. No post-operative complications were developed. All patients were discharged with Glasgow Outcome Score of 5. CONCLUSION Because of the rarity of the lesion and small number of patients, definitive conclusions may be misleading but we think that, in experienced hands, midline epidural hematomas can safely be operated on and, preservation of midline bone strip pro-vides easier bleeding control.
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MESH Headings
- Child
- Fractures, Bone/surgery
- Hematoma, Epidural, Cranial/diagnostic imaging
- Hematoma, Epidural, Cranial/etiology
- Hematoma, Epidural, Cranial/surgery
- Hematoma, Epidural, Spinal/surgery
- Humans
- Neurosurgical Procedures/adverse effects
- Tomography, X-Ray Computed
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Affiliation(s)
- Doğan Güçlühan Güçlü
- Department of Neurosurgery, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul-Turkey
| | - Onur Öztürk
- Department of Neurosurgery, Çerkezköy State Hospital, Tekirdağ-Turkey
| | - Musa Çırak
- Department of Neurosurgery, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul-Turkey
| | - Halil Can
- Department of Neurosurgery, Biruni University Faculty of Medicine, İstanbul-Turkey
| | - Tuğrul Cem Ünal
- Department of Neurosurgery, İstanbul University Istanbul Faculty of Medicine, İstanbul-Turkey
| | - İlyas Dolaş
- Department of Neurosurgery, İstanbul University Istanbul Faculty of Medicine, İstanbul-Turkey
| | - Utku Özgen
- Department of Neurosurgery, İstanbul University Istanbul Faculty of Medicine, İstanbul-Turkey
| | - Aydın Aydoseli
- Department of Neurosurgery, İstanbul University Istanbul Faculty of Medicine, İstanbul-Turkey
| | - Altay Sencer
- Department of Neurosurgery, İstanbul University Istanbul Faculty of Medicine, İstanbul-Turkey
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14
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Aydoseli A, Unal TC, Dolas I, Dagdeviren HE, Kucuk C, Barburoglu M, Sencer A. Evaluation of the usefulness of an expandable stent for establishing patency in endoscopic third ventriculostomy: a fresh cadaveric study. Turk Neurosurg 2022; 32:330-335. [DOI: 10.5137/1019-5149.jtn.37281-21.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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15
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Dolen D, Ahmadov T, Dolas I, Unal TC, Aydoseli A, Ozturk M, Sabanci PA, Aras Y, Bilgic MB, Sencer A. Analysis of the prognosis of high-grade gliomas in the view of new immunohistochemistry markers and 2016 who classification. Turk Neurosurg 2022; 32:500-507. [DOI: 10.5137/1019-5149.jtn.40005-22.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Unal TC, Gulsever CI, Sahin D, Dagdeviren HE, Dolas I, Sabanci PA, Aras Y, Sencer A, Aydoseli A. Versatile Use of Intraoperative Ultrasound Guidance for Brain Puncture. Oper Neurosurg (Hagerstown) 2021; 21:409-417. [PMID: 34624101 DOI: 10.1093/ons/opab330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/18/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Intraoperative ultrasound (iUS) is an effective guidance and imaging system commonly used in neuro-oncological surgery. Despite the versatility of iUS, its utility for single burr hole puncture guidance remains fairly underappreciated. OBJECTIVE To highlight the simplicity, versatility, and effectiveness of iUS guidance in brain puncture by presenting the current case series and technical note collection. METHODS We present 4 novel uses of iUS guidance for single burr hole brain puncture: cannulation of normal-sized ventricles, endoscopic third ventriculostomy (ETV) guidance, evacuation of interhemispheric empyema, and stereotactic biopsy assistance. RESULTS All techniques were performed successfully in a total of 16 patients. Normal-sized ventricles were cannulated in 7 patients, among whom 5 underwent Ommaya reservoir placement and 2 underwent ventriculoperitoneal shunt placement for idiopathic intracranial hypertension. No more than 1 attempt was needed for cannulation. All ventricular tip positions were optimal as shown by postoperative imaging. iUS guidance was used in 5 ETV procedures. The working cannula was successfully introduced to the lateral ventricle, providing the optimal trajectory to the third ventricular floor in these cases. Interhemispheric subdural empyema was aspirated with iUS guidance in 1 patient. Volume reduction was clearly visible, allowing near-total evacuation of the empyema. iUS guidance was used for assistive purposes during stereotactic biopsy in 3 patients. No major perioperative complications were observed throughout this series. CONCLUSION iUS is an effective and versatile guidance system that allows for real-time imaging and can be easily and safely employed for various brain puncture procedures.
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Affiliation(s)
- Tugrul Cem Unal
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Cafer Ikbal Gulsever
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Duran Sahin
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Huseyin Emre Dagdeviren
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ilyas Dolas
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Pulat Akin Sabanci
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yavuz Aras
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Altay Sencer
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Aydoseli
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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17
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Unal TC, Aydoseli A, Ozgen U, Dolas I, Sabanci PA, Aras Y, Ozturk M, Ozata MS, Gul N, Kubat Uzum A, Mutlu U, Bilgic B, Saka E, Yarman S, Sencer A. A single-center experience of transsphenoidal endoscopic surgery for acromegaly in 73 patients: results and predictive factors for remission. Br J Neurosurg 2021:1-6. [PMID: 34241568 DOI: 10.1080/02688697.2021.1947977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 05/29/2021] [Accepted: 06/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Transsphenoidal endoscopic surgery is the first-line treatment for growth hormone-secreting adenomas. OBJECTIVE To analyse the results of the transsphenoidal endoscopic approach for acromegaly and to determine the predictive factors of remission. METHODS A single-centre retrospective review was performed in patients who underwent endoscopic transsphenoidal surgery for acromegaly between January 2009 and January 2019. Demographic features, clinical presentation, histopathology records, complications and pre- and postoperative radiologic and endocrinological assessments were evaluated. The factors that influenced the remission rates were investigated. RESULTS A total of 73 patients underwent surgery via the transsphenoidal endoscopic approach. Cavernous sinus invasion was detected in 32 patients (43.8%); and macroadenoma, in 57 (78%). The pathology specimens of the 27 patients (36.9%) showed dual-staining adenomas with prolactin. A total of 51 patients (69.8%) attained biochemical remission 1 year after surgery. A second operation was performed in 10 patients (13.6%) with residual tumours without biochemical remission in the first year. Six (60%) of the patients attained remission at the last follow-up. Transient diabetes insipidus was observed in 18 patients (24.6%); and rhinorrhoea, which was resolved with conservative treatment, in 4 (5.4%). None of the patients developed panhypopituitarism. The presence of cavernous sinus invasion and preoperative IGF-1, immediate postoperative GH and third-month IGF-1 levels were predictive of remission. CONCLUSION Transsphenoidal endoscopic surgery is a safe and effective treatment for acromegaly. Reoperation should be considered in patients with residual tumours without remission.
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Affiliation(s)
- Tugrul Cem Unal
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Aydoseli
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Utku Ozgen
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ilyas Dolas
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Pulat Akin Sabanci
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yavuz Aras
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Metehan Ozturk
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Musa Samet Ozata
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nurdan Gul
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ayse Kubat Uzum
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ummu Mutlu
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Bilge Bilgic
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Esra Saka
- Department of Anesthesiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sema Yarman
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Altay Sencer
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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18
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Sabanci PA, Unal TC, Ozturk O, Dolen D, Dolas I, Peker B, Saka E, Ali A, Aydoseli A, Aras Y, Sencer A, Hepgul K, Izgi N, Barlas O. Effect of Intraoperative Computed Tomography on Ventriculoperitoneal Shunt Survival. World Neurosurg 2021; 153:e373-e379. [PMID: 34217860 DOI: 10.1016/j.wneu.2021.06.106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND In patients with hydrocephalus who undergo ventriculoperitoneal shunt placement, the ventricular catheter tip position is one of the most important prognostic factors influencing shunt survival. The aim of this study was to present our findings of ventriculoperitoneal shunt placement performed with intraoperative computed tomography (CT) and to evaluate the effect of intraoperative CT-based image guidance on optimal catheter positioning and overall shunt survival. METHODS Of the study enrolled 345 patients with hydrocephalus who underwent ventriculoperitoneal shunt placement for the first time between 2008 and 2018. Ventricular catheters were inserted freehand via the Kocher point into the lateral ventricle in all patients. In 163 patients, intraoperative CT was performed to confirm the tip position. In this group of patients, if the tip position was nonoptimal, the catheter was ejected and reinserted during the surgery. In the remaining 182 patients, the tip position was assessed with routine postoperative CT. The effect of performing intraoperative CT on catheter tip positioning and shunt failure was investigated. RESULTS Nonoptimal tip position was significantly correlated with shunt dysfunction even when excluding nonobstructive causes (P < 0.001). In the intraoperative CT group, 11 ventricular catheters (6.7%) were intraoperatively repositioned. The repositioning significantly improved the optimal tip position rate from 54% to 58.3% (P = 0.007). Intraoperative CT usage also showed direct correlation with shunt survival (P = 0.006). CONCLUSIONS Intraoperative CT is an effective tool for increasing the rate of optimal tip positioning and thereby overall shunt survival.
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Affiliation(s)
- Pulat Akin Sabanci
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Tugrul Cem Unal
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
| | - Onur Ozturk
- Department of Neurosurgery, Cerkezkoy State Hospital, Tekirdag, Turkey
| | - Duygu Dolen
- Department of Neurosurgery, Yuksekova State Hospital, Hakkari, Turkey
| | - Ilyas Dolas
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Baris Peker
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Esra Saka
- Department of Neurosurgery, Cerkezkoy State Hospital, Tekirdag, Turkey
| | - Achmet Ali
- Department of Anesthesiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Aydin Aydoseli
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Yavuz Aras
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Altay Sencer
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Kemal Hepgul
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Nail Izgi
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Orhan Barlas
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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19
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Mail Gurkan Z, Sirin NG, Kara B, Gul G, Sengul Eren F, Tekin Guveli B, Velioglu S, Sabanci A, Aydoseli A, Aras Y, Bebek N, Baykan B, Sencer A, Canbolat AT, Gokyigit A, Aydogan Culha U, Gurses C. SURGICAL TREATMENT IN REFRACTORY EPILEPSY: SEIZURE OUTCOME RESULTS BASED ON INVASIVE EEG MONITORIZATION. Turk Neurosurg 2021; 32:143-148. [PMID: 34664705 DOI: 10.5137/1019-5149.jtn.32796-20.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM Epilepsy surgery is an effective treatment in patients suffering from refractory epilepsy. In this study, the aim is to discuss seizure outcomes of patients, who had had invasive EEG monitorization (IEM), following their epilepsy surgery at our centre. MATERIAL AND METHODS Forty-seven patients suffering from refractory epilepsy and who were evaluated by invasive EEG were included in this retrospective study at Istanbul Faculty of Medicine from 2003 to 2017. We examined the Video EEG and invasive EEG monitorization, cranial MRI, SPECT, PET and neuropsychological tests of all patients. Moreover, postoperative seizure outcome results were evaluated according to Engel classification. The factors affecting seizure outcome were discussed. RESULTS Twenty-six of the patients were female (55.3%), 21 were male (44.7). The average age were 32.0 (±12.4). Forty-three patients had surgery and the average age of these patients was 26,6 (±11,15). 38.3% of the patients had hippocampal sclerosis (HS), 23.4% had focal cortical dysplasia (FCD), 8.5% had tumor, 14.9% had sequela lesion and 14.9% had unknown etiology. Postoperative seizure status according to the Engel classification showed that 81.6% of the patients were class I, 10.5% were class II, 2,6% were class III and 5,3% were class IV. CONCLUSION A significant relation was statistically determined between structural MRI lesion and favorable seizure outcome (p 0.05). The most frequent etiology was HS in our patients. Of the patients with Engel I, the averages of their ages, ages at onset of epilepsy and ages at surgery were lower than other groups; but the difference was not statistically significant (p 0.05). We argue that IEM is an essential examination for favorable outcome for the determination of epileptogenic zone and/or the proximity of the functional structures.
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Affiliation(s)
- Zahide Mail Gurkan
- University of Health Sciences Gaziosmanpasa Training and Research Hospital
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20
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Aydoseli A, Unal TC, Kardes O, Doguc O, Dolas I, Adiyaman AE, Ortahisar E, Silahtaroglu G, Aras Y, Sabanci PA, Sencer S, Sencer A. An early warning system using machine learning for the detection of intracranial hematomas in the emergency trauma setting. Turk Neurosurg 2021; 32:459-465. [DOI: 10.5137/1019-5149.jtn.35996-21.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Can H, Diren F, Peker B, Gomleksiz C, Guclu DG, Kucuk C, Civelek E, Aydoseli A, Sencer A. Morphometric Analysis of Lumbar Arteries and Relationship with Intervertebral Discs: A study of Surgical Anatomy on Human Fresh Cadavers. Turk Neurosurg 2020; 30:577-582. [PMID: 32530478 DOI: 10.5137/1019-5149.jtn.29021-20.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
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.
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Affiliation(s)
- Halil Can
- Biruni University, School of Medicine, Department of Neurosurgery, Istanbul, Turkey
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22
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Orhan KS, Çelik M, Polat B, Aydemir L, Aydoseli A, Sencer A, Güldiken Y. Endoscope-Assisted Surgery for Petrous Bone Cholesteatoma with Hearing Preservation. J Int Adv Otol 2020; 15:391-395. [PMID: 31846917 DOI: 10.5152/iao.2019.7212] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Petrous bone cholesteatoma is a rare pathologic entity and may be a difficult surgical challenge because of potential involvement of the facial nerve, carotid artery, dura mater, otic capsule and superior petrosal or lateral sinus. The objective of this article is to present the endoscope-assisted surgery for petrous bone cholesteatoma. MATERIALS AND METHODS Eight patients (nine ears) who underwent endoscope-assisted petrous bone surgery for cholesteatoma. Pure tone audiogram, magnetic resonance imaging were performed at preoperatively, and at approximately 12 months postoperatively. RESULTS Endoscope assisted surgery was performed in 8 patients and 9 ears. Of these patients, 6 were male and 2 were females. Median age was 19,5 (range 7-52) years. Hearing was able to preserved in 8 ears (8/9). Recurrence disease was observed one ear in long term follow up (1/9). In another one patient, cholesteatoma pearl was removed in the office. CONCLUSION Endoscope-assisted surgery can allow removal of cholesteatoma of petrous apex with preserving hearing. It also provides to remove the cholesteatoma via transmastoid approach for perilabyrinthine space as "minimally invasive surgery" instead of middle fossa approach that is standard surgical procedure. In apical and peri-labyrinthine cholesteatomas, endoscopes allow to preserve hearing with middle fossa approach instead of trans-otic/ trans-labyrinthine/trans-cochlear approach.
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Affiliation(s)
- Kadir Serkan Orhan
- Department of Otorhinolaryngology, İstanbul University School of Medicine, İstanbul, Turkey
| | - Mehmet Çelik
- Department of Otorhinolaryngology, İstanbul University School of Medicine, İstanbul, Turkey
| | - Beldan Polat
- Department of Otorhinolaryngology, İstanbul University School of Medicine, İstanbul, Turkey
| | - Levent Aydemir
- Department of Otorhinolaryngology, İstanbul University School of Medicine, İstanbul, Turkey
| | - Aydın Aydoseli
- Department of Neurosurgery, İstanbul University School of Medicine, İstanbul, Turkey
| | - Altay Sencer
- Department of Neurosurgery, İstanbul University School of Medicine, İstanbul, Turkey
| | - Yahya Güldiken
- Department of Otorhinolaryngology, İstanbul University School of Medicine, İstanbul, Turkey
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23
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Can H, Unal TC, Dolas I, Guclu G, Diren F, Dolen D, Gomleksiz C, Aydoseli A, Civelek E, Sencer A. Comprehensive Anatomic and Morphometric Analyses of Triangular Working Zone for Transforaminal Endoscopic Approach in Lumbar Spine: A Fresh Cadaveric Study. World Neurosurg 2020; 138:e486-e491. [PMID: 32147551 DOI: 10.1016/j.wneu.2020.02.160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The aim of this study is to provide essential information for endoscopic transforaminal approach by performing morphometric analysis of the triangular working zone (TWZ) in fresh cadavers. METHODS Fifteen fresh human cadavers (9 women and 6 men) with no history of spinal surgery were used in this study. Anatomic dissection of 150 foraminal levels were performed. Significant surgical landmarks constructing TWZ were measured bilaterally from L1-2 to L5-S1 on 15 fresh cadavers. The relationship between traversing roots and intervertebral discs was defined. RESULTS Base, height, and hypotenuse measurements of TWZ were longer as the level lowered. Mean base height and hypotenuse of TWZ were 12.15 mm, 11.29 mm, and 16.69 mm (L1-2); 17.94 mm, 17.18 mm, and 28.03 mm (L5-S1), respectively. TWZ was triangular shaped at the upper lumbar levels (L1-2, L2-3, and L3-4), and trapezoid at the lower lumbar levels (L4-5 and L5-S1). Going down the levels, the exiting root angle was narrower, the mean exiting angle of the L5 root being 28.23°. All L2 and L3 traversing roots and nearly all L4 traversing roots (86.7%) originated from below the disc level. Forty percent of L5 traversing roots originated above the disc level, and 53.3% originated at the disc level. Most S1 traversing roots originated at the proximal margin of the disc level (80%). CONCLUSIONS Our study reveals a detailed morphometric analysis of TWZ. Understanding the foraminal anatomy is crucial for safely performing transforaminal endoscopic surgery. The learning curve of transforaminal surgery can be reduced by garnering knowledge of TWZ anatomy.
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Affiliation(s)
- Halil Can
- Department of Neurosurgery, Biruni University Faculty of Medicine, Istanbul, Turkey; Department of Neurosurgery, Medicine Hospital, Istanbul, Turkey
| | - Tugrul Cem Unal
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
| | - Ilyas Dolas
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Gucluhan Guclu
- Department of Neurosurgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Furkan Diren
- Department of Neurosurgery, Gaziosmanpasa Taksim Training and Research Hospital, Istanbul, Turkey
| | - Duygu Dolen
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Cengiz Gomleksiz
- Department of Neurosurgery, Silivri State Hospital, Istanbul, Turkey
| | - Aydin Aydoseli
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Erdinc Civelek
- Department of Neurosurgery, Gaziosmanpasa Taksim Training and Research Hospital, Istanbul, Turkey
| | - Altay Sencer
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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24
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Can H, Gomleksiz C, Diren F, Civelek E, Kircelli A, Aydoseli AN, Sencer A. Anatomical Features of Neural Foramen at T12â€"L1 Level for Endoscopic Transforaminal Approach of Paramedian and Foraminal Disc Herniations: An Anatomical Study on Fresh Human Cadavers. Turk Neurosurg 2019; 30:78-82. [PMID: 31736029 DOI: 10.5137/1019-5149.jtn.26646-19.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
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.
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Affiliation(s)
- Halil Can
- Biruni University, School of Medicine, Department of Neurosurgery and Private Medicine Hospital, Neurosurgery Clinic, Istanbul, Turkey
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Goker B, Guclu DG, Dolas I, Ozgen U, Altunrende ME, Akinci AT, Sencan F, Aydoseli A, Can H, Sencer A. Clinical Study of Decompressive Craniectomy in Children. Turk Neurosurg 2019; 30:225-230. [PMID: 31608977 DOI: 10.5137/1019-5149.jtn.27576-19.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
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.
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Affiliation(s)
- Burcu Goker
- Istinye University School of Medicine, Liv Hospital-Ulus, Department of Neurosurgery, Istanbul, Turkey
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Liu S, Gurses C, Sha Z, Quach MM, Sencer A, Bebek N, Curry DJ, Prabhu S, Tummala S, Henry TR, Ince NF. Stereotyped high-frequency oscillations discriminate seizure onset zones and critical functional cortex in focal epilepsy. Brain 2019; 141:713-730. [PMID: 29394328 DOI: 10.1093/brain/awx374] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 11/12/2017] [Indexed: 01/25/2023] Open
Abstract
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 correlated with independently clinician-defined seizure onset zones. Consistently in all patients, the stereotypical high-frequency oscillations with the highest degree of waveform similarity were localized within the seizure onset zones only, whereas the channels generating high-frequency oscillations embedded in random waveforms were found in the functional regions independent from the epileptogenic locations. The repetitive waveform pattern was more evident in fast ripples compared to ripples, suggesting a potential association between waveform repetition and the underlying pathological network. Our findings provided a new tool for the interpretation of pathological high-frequency oscillations that can be efficiently applied to distinguish seizure onset zones from functionally important sites, which is a critical step towards the translation of these signature events into valid clinical biomarkers.awx374media15721572971001.
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Affiliation(s)
- Su Liu
- Department of Biomedical Engineering, University of Houston, Houston, Texas, USA
| | - Candan Gurses
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zhiyi Sha
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael M Quach
- Department of Neurology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Altay Sencer
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey, USA
| | - Nerses Bebek
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Daniel J Curry
- Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Sujit Prabhu
- Department of Neurosurgery, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Sudhakar Tummala
- Department of Neurosurgery, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Thomas R Henry
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Nuri F Ince
- Department of Biomedical Engineering, University of Houston, Houston, Texas, USA
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Gömleksiz C, Can H, Yaka U, Göker B, Aydoseli A, Barburoğlu M, Sencer A, Sencer S, Özgen U, Yörükoğlu AG. THE MOTION RANGE OF THE CONUS MEDULLARIS MOVEMENT WITH SERIAL MAGNETIC RESONANCE IMAGING IN SUPINE AND PRONE POSITIONS: RESULTS OF FOURTY HEALTHY SUBJECTS. J Istanb Fac Med 2019. [DOI: 10.26650/iuitfd.435784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Can H, Aydoseli A, Gömleksiz C, Göker B, Altunrende ME, Dolgun M, Sencer A. Combined and individual use of pancaspase inhibitor Q-VD-OPh and NMDA receptor antagonist riluzole in experimental spinal cord injury. ULUS TRAVMA ACIL CER 2018; 23:452-458. [PMID: 29115658 DOI: 10.5505/tjtes.2017.09694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND We investigated the effects of an N-methyl-D-aspartate receptor antagonist, riluzole, and a pancaspase inhibitor and basic apoptosis mediator, Q-VD-OPh, in combination or alone in posttraumatic spinal cord injury. METHODS In our study, 45 healthy male Sprague Dawley rats were used. Spinal trauma was induced by the clip compression technique via thoracal 7, 8, 9 laminectomies. After inducing the trauma, the drug was continuously administered intraperitoneally for 5 days. After inducing the trauma, the subjects were assessed using Tarlov's motor grading scale and inclined plane test. Five days after the trauma, the spinal cord specimens were harvested, and a histopathological examination was performed. RESULTS Compared with the other groups, a statistically significant difference with regard to better results for necrosis, inflammation, and apoptosis was observed in the riluzole only and combination groups. Statistically better motor function scores were observed in the Q-VD-OPh only group than in the other groups. CONCLUSION With regard to limiting secondary damage after trauma, statistically significant results were observed in the Q-VDOPh only and Q-VD-OPh-riluzole combination groups. More extensive laboratory studies are required to limit and control the effects of secondary damage after spinal cord trauma.
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Affiliation(s)
| | | | | | - Burcu Göker
- Department of Neurosurgery, Liv Hospital, İstanbul-Turkey.
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Jiang T, Liu S, Pellizzer G, Aydoseli A, Karamursel S, Sabanci PA, Sencer A, Gurses C, Ince NF. Characterization of Hand Clenching in Human Sensorimotor Cortex Using High-, and Ultra-High Frequency Band Modulations of Electrocorticogram. Front Neurosci 2018. [PMID: 29535603 PMCID: PMC5835101 DOI: 10.3389/fnins.2018.00110] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Functional mapping of eloquent cortex before the resection of a tumor is a critical procedure for optimizing survival and quality of life. In order to locate the hand area of the motor cortex in two patients with low-grade gliomas (LGG), we recorded electrocorticogram (ECoG) from a 113 channel hybrid high-density grid (64 large contacts with diameter of 2.7 mm and 49 small contacts with diameter of 1 mm) while they executed hand clenching movements. We investigated the spatio-spectral characteristics of the neural oscillatory activity and observed that, in both patients, the hand movements were consistently associated with a wide spread power decrease in the low frequency band (LFB: 8–32 Hz) and a more localized power increase in the high frequency band (HFB: 60–280 Hz) within the sensorimotor region. Importantly, we observed significant power increase in the ultra-high frequency band (UFB: 300–800 Hz) during hand movements of both patients within a restricted cortical region close to the central sulcus, and the motor cortical “hand knob.” Among all frequency bands we studied, the UFB modulations were closest to the central sulcus and direct cortical stimulation (DCS) positive site. Both HFB and UFB modulations exhibited different timing characteristics at different locations. Power increase in HFB and UFB starting before movement onset was observed mostly at the anterior part of the activated cortical region. In addition, the spatial patterns in HFB and UFB indicated a probable postcentral shift of the hand motor function in one of the patients. We also compared the task related subband modulations captured by the small and large contacts in our hybrid grid. We did not find any significant difference in terms of band power changes. This study shows initial evidence that event-driven neural oscillatory activity recorded from ECoG can reach up to 800 Hz. The spatial distribution of UFB oscillations was found to be more focalized and closer to the central sulcus compared to LFB and HFB. More studies are needed to characterize further the functional significance of UFB relative to LFB and HFB.
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Affiliation(s)
- Tianxiao Jiang
- Clinical Neural Engineering Lab, Department of Biomedical Engineering, University of Houston, Houston, TX, United States
| | - Su Liu
- Clinical Neural Engineering Lab, Department of Biomedical Engineering, University of Houston, Houston, TX, United States
| | - Giuseppe Pellizzer
- Research Service, Minneapolis VA Health Care System, Departments of Neurology and Neuroscience, University of Minnesota, Minnesota, MN, United States
| | - Aydin Aydoseli
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sacit Karamursel
- Department of Physiology, Faculty of Medicine, Istinye University, Istanbul, Turkey
| | - Pulat A Sabanci
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Altay Sencer
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Candan Gurses
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nuri F Ince
- Clinical Neural Engineering Lab, Department of Biomedical Engineering, University of Houston, Houston, TX, United States
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Ali A, Tanirgan G, Sabanci PA, Sivrikoz N, Abdullah T, Sencer A, Sencer S, Orhan-Sungur M, Akinci IO. Relation of gray-white matter ratio with long-term cognitive functions and quality of life in patients with mild to moderate aneurysmal subarachnoid hemorrhage: a prospective observational study. Acta Neurochir (Wien) 2018; 160:181-189. [PMID: 29075902 DOI: 10.1007/s00701-017-3374-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 10/17/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND In the present study, we hypothesized that a low gray matter-white matter ratio (GWR) is associated with poor cognitive function and low quality of life in patients with mild to moderate (WFNS ≤3) aneurysmal subarachnoid hemorrhage (aSAH). METHODS All patients with aSAH who were admitted to the neurointensive care unit (Neuro ICU) and whose WFNS score was ≤ 3 were enrolled in the study. During the Neuro ICU follow-up period, the following variables were recorded: demographics, neurological status, comorbidities, time elapsed between onset of bleeding and Neuro ICU admission, treatment method, number of days with vasospasm symptoms (DVS) and vasopressor usage. One year after bleeding, all patients except those who could not answer the questionnaires appropriately were administered the MoCA and SF-36 tests, and brain magnetic resonance imaging and then volumetric brain analysis were performed. RESULTS Eighty-two patients completed the study. One year after aSAH, cognitive dysfunction and low quality of life were observed in 59.8% and 25.6% of patients, respectively. Among the variables obtained during Neuro ICU follow-up, DVS was found to be a major risk factor for cognitive dysfunction (OR: 3.9, 95% CI: 1.9-7.8; p < 0.001), poor quality of life (OR: 2.8, 95% CI: 1.4-5.3, p = 0.002) and a lower GWR value (p < 0.001, correlation coefficient = -0.410, R2 = 0.234). One year after aSAH, higher GWR values were associated with higher MoCA (R2 = 0.506 for males, R2 = 0.413 for females) and SF-36 (R2 = 0.270 for males, R2 = 0.364 for females) scores in both genders. Also, GWR ≤ 1.35 in males and GWR ≤1.33 in females indicated MoCApoor patients with over 80% specificity and sensitivity. CONCLUSION GWR has good correlation with the MoCA and SF-36 score, and a low GWR can indicate cognitive dysfunction. In this context, GWR can be used as an additional method to evaluate cognitive function and quality of life.
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Affiliation(s)
- Achmet Ali
- Department of Anesthesiology and Reanimation, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Gamze Tanirgan
- Department of Anesthesiology and Reanimation, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Pulat Akin Sabanci
- Department of Neurosurgery, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Nukhet Sivrikoz
- Department of Anesthesiology and Reanimation, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Taner Abdullah
- Department of Anesthesiology and Reanimation, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Altay Sencer
- Department of Neurosurgery, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Serra Sencer
- Department of Neuroradiology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Mukadder Orhan-Sungur
- Department of Anesthesiology and Reanimation, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Ibrahim Ozkan Akinci
- Department of Anesthesiology and Reanimation, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey.
- İ.Ü. İstanbul Tıp Fakültesi Anesteziyoloji ABD, Turgut Ozal Cad, Fatih, Istanbul, Turkey.
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Aydin K, Sencer S, Barburoglu M, Berdikhojayev M, Aras Y, Sencer A, İzgi N. Midterm results of T-stent–assisted coiling of wide-necked and complex intracranial bifurcation aneurysms using low-profile stents. J Neurosurg 2017; 127:1288-1296. [DOI: 10.3171/2016.9.jns161909] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVECoiling of wide-necked and complex bifurcation aneurysms frequently requires implantation of double stents in various configurations. T-stent–assisted coiling involves the nonoverlapping implantation of 2 stents to protect the daughter vessels of bifurcation and is followed by coiling of the aneurysm. The authors studied the feasibility, efficacy, and safety of the T-stent–assisted coiling procedure as well as the midterm angiographic/clinical outcomes of patients with wide-necked bifurcation intracranial aneurysms treated using this technique.METHODSThe authors retrospectively identified patients with wide-necked bifurcation intracranial aneurysms treated using double-stent–assisted coiling with a T-stent configuration.RESULTSTwenty-four patients with 24 aneurysms and a mean of age of 51.91 years were identified. The most common locations were the middle cerebral bifurcation (45.8%) and anterior communicating artery (35.7%). T stentings were performed using low-profile stents. The procedures were performed with a technical success rate of 95.8%, and an immediate total occlusion rate of 79.2% was achieved. We observed periprocedural complications in 16.7% of cases and a delayed thromboembolic event in 4.2%. The complications caused permanent morbidity in 1 patient (4.2%). No deaths occurred. The mean angiographic follow-up duration was 9.3 months. The total occlusion rate at the last follow-up was 81.2%. The recanalization rate was 4.5%. Modified Rankin Scale scores of all patients at the last follow-ups were between zero and 2.CONCLUSIONST-stent–assisted coiling using low-profile stents is a feasible, effective, and relatively safe endovascular technique used to treat wide-necked and complex intracranial aneurysms. The midterm angiographic and clinical outcomes are outstanding.
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Affiliation(s)
- Kubilay Aydin
- 1Department of Radiology, Neuroradiology Division, and
- 2Department of Radiology, Koc University Hospital, Topkapi, Istanbul, Turkey; and
| | - Serra Sencer
- 1Department of Radiology, Neuroradiology Division, and
| | | | | | - Yavuz Aras
- 4Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Capa
| | - Altay Sencer
- 4Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Capa
| | - Nail İzgi
- 4Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Capa
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Unal TC, Unal OF, Barlas O, Hepgul K, Ali A, Aydoseli A, Aras Y, Sabanci PA, Sencer A, Izgi N. Factors Determining the Outcome in Trigeminal Neuralgia Treated With Percutaneous Balloon Compression. World Neurosurg 2017; 107:69-74. [DOI: 10.1016/j.wneu.2017.07.132] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/20/2017] [Accepted: 07/22/2017] [Indexed: 10/19/2022]
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Yörükoğlu AG, Göker B, Tahta A, Akçakaya MO, Aydoseli A, Sabancı PA, Aras Y, Alkır G, Sencer A, Imer M, Izgi N, Canbolat AT. Fully endoscopic interlaminar and transforaminal lumbar discectomy: Analysis of 47 complications encountered in a series of 835 patients. Neurocirugia (Astur) 2017; 28:235-241. [PMID: 28532963 DOI: 10.1016/j.neucir.2017.03.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 03/05/2017] [Accepted: 03/24/2017] [Indexed: 12/12/2022]
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Kamar C, Ali A, Altun D, Orhun G, Sabancı A, Sencer A, Akıncı İÖ. Evaluation of risk factors and development of acute kidney injury in aneurysmal subarachnoid hemorrhage, head injury, and severe sepsis/septic shock patients during ICU treatment. ULUS TRAVMA ACIL CER 2017; 23:39-45. [PMID: 28261769 DOI: 10.5505/tjtes.2016.83451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND There are few studies examining development of acute kidney injury (AKI) in the various types of patients in intensive care units (ICUs). Presently described is evaluation of risk factors and development of AKI in different groups of ICU patients. METHODS Present study was performed in 3 different ICUs. Development of AKI was measured using Acute Kidney Injury Network (AKIN) classification system. Total of 300 patients who were treated in trauma, neurosurgery, or general ICU departments (due to head injury, aneurysmal subarachnoid hemorrhage [aSAH], or severe sepsis/septic shock, respectively) were assessed for incidence, risk factors, and development of AKI. RESULTS AKI did not develop in aSAH patients when evaluated based on serum creatinine level; however, it was observed in 5% of aSAH patients according to volume adjusted creatinine (VACr) level. AKI developed in 76% of sepsis group, and in 20% of head injury group, based on AKIN classification, according to both serum and VACr levels. Incidence of AKI was significantly higher in sepsis group (p<0.001). Only use of vasopressor was significantly related to AKI development in sepsis and head injury groups. Mortality rate was 8%, 22%, and 42% in aSAH, head injury, and sepsis groups, respectively. AKI development and vasopressor use were significantly related to mortality in sepsis group. CONCLUSION Despite similar characteristics and risk factors, there were fewer instances of AKI in aSAH group. Hypertension or hydration therapy used to treat vasospasm and polyuria due to cerebral salt-wasting syndrome may prevent aSAH patients from developing AKI.
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Affiliation(s)
| | | | | | | | | | | | - İbrahim Özkan Akıncı
- Department of Anesthesiology, İstanbul University İstanbul Faculty of Medicine, İstanbul-Turkey.
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Sabanci PA, Omay B, Aras Y, Aydoseli A, Ali A, Erdem T, Sencer A, Kiris T. Effect of Visible Light on Vasospasticity of Post-Subarachnoid Hemorrhage Cerebrospinal Fluid. J Neurol Surg A Cent Eur Neurosurg 2017; 78:548-555. [PMID: 28597450 DOI: 10.1055/s-0036-1594005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background and Objective Cerebral vasospasm (CV) is a serious complication of subarachnoid hemorrhage (SAH) with high morbidity and mortality rates. The mechanism of CV has not been determined. There are many theories related to this unsolved issue, one of which supports CV as a two-stage phenomenon from a pathophysiologic perspective. The first stage consists of inhibition of neuronal nitric oxide synthase by oxyhemoglobin, which results in a decrease of nitric oxide (NO) production. The second stage consists of an increase in the levels of asymmetric dimethylarginine through bilirubin oxidation products (BOXes), which are oxidized by-products of hemoglobin metabolism. These in turn inhibit endothelial nitric oxide synthase (eNOS), which results in the blockage of the second NO production mechanism. BOXes are sensitive to visible light, as is their precursor bilirubin. The hypothesis of CV prevention using the photosensitivity of BOXes was tested in this study. Material and Methods Cerebrospinal fluid (CSF) obtained from two patients with SAH was divided in half and either exposed to a standard dose of visible light or not exposed to any light. The CSF was spectrophotometrically investigated and the concentration of BOXes was measured. A comparison between CSF samples exposed to light and not exposed to light was made. Using two groups of 16 rats each, the vasospastic effect of the CSF exposed and not exposed to light on arteries of the cortical surface was measured. The cortex was exposed using the cranial window. Results Spectrophotometric analysis revealed that the concentration of BOXes in the CSF decreased significantly after being exposed to visible light (p < 0.001). There was a significant difference of the vasospastic effect of CSF on exposed cortical arteries (p < 0.001). Conclusion The concentration of BOXes and the vasospastic effect of CSF taken from patients with SAH were significantly reduced after being exposed to visible light if compared with CSF not exposed to light.
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Affiliation(s)
- Pulat Akin Sabanci
- Department of Neurosurgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Bulent Omay
- Department of Neurosurgery, Yale University, School of Medicine, New Haven, Connecticut, United States
| | - Yavuz Aras
- Department of Neurosurgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Aydın Aydoseli
- Department of Neurosurgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Achmet Ali
- Department of Anesthesiology, Istanbul Universitesi Istanbul Tip Fakultesi, Istanbul, Istanbul, Turkey
| | - Tulin Erdem
- Department of General ICU, Anadolu Saglik Merkezi, Kocaeli, Turkey
| | - Altay Sencer
- Department of Neurosurgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Talat Kiris
- Department of Neurosurgery, Liv Hospital, Istinye University, İstanbul, Turkey
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Vanli-Yavuz EN, Baykan B, Sencer S, Sencer A, Baral-Kulaksizoglu I, Bebek N, Gurses C, Gokyigit A. How Different Are the Patients With Bilateral Hippocampal Sclerosis From the Unilateral Ones Clinically? Clin EEG Neurosci 2017; 48:209-216. [PMID: 27287222 DOI: 10.1177/1550059416653900] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE There is a lack of knowledge on consecutive patients with epilepsy associated with bilateral hippocampal sclerosis (BHS). We aimed to investigate the differentiating features of BHS in comparison with unilateral HS (UHS). METHOD We investigated our database for patients with epilepsy fulfilling the major magnetic resonance imaging criteria for BHS; namely, presence of bilateral atrophy and high signal changes on T2 and FLAIR series in the hippocampi. UHS patients seen in past 2 years were included as the control group. Clinical, EEG, and other laboratory findings, data on treatment response and epilepsy surgery were investigated from their files. RESULTS A total of 124 patients (31 with BHS and 93 with UHS; 49 right-sided and 44 left-sided) were included. We found that 16.1% of the BHS and 18.3% of the UHS groups were not drug-refractory. A binary logistic regression analysis performed with significant clinical features disclosed that history of febrile status epilepticus, mental retardation, and status epilepticus were statistically more common in BHS group. Moreover, diagnosis of psychosis established by an experienced psychiatrist and slowing of the EEG background activity were both found significantly more frequent in BHS. 66.67% of the operated BHS patients showed benefit from epilepsy surgery. CONCLUSIONS BHS is a heterogeneous group, showing significant differences such as increased frequencies of mental retardation, status epilepticus, febrile status epilepticus and psychosis, in comparison to UHS. In all, 16.1% of the BHS cases showed a benign course similar to the UHS group and some patients with drug-resistant epilepsy may show benefit from epilepsy surgery.
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Affiliation(s)
- Ebru Nur Vanli-Yavuz
- 1 Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.,2 School of Medicine, Department of Neurology, Koç University, Istanbul, Turkey
| | - Betul Baykan
- 1 Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Serra Sencer
- 3 Department of Neuroradiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Altay Sencer
- 4 Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Isin Baral-Kulaksizoglu
- 5 Department of Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nerses Bebek
- 1 Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Candan Gurses
- 1 Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aysen Gokyigit
- 1 Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Vanli-Yavuz EN, Erdag E, Tuzun E, Ekizoglu E, Baysal-Kirac L, Ulusoy C, Peach S, Gundogdu G, Sencer S, Sencer A, Kucukali CI, Bebek N, Gurses C, Gokyigit A, Baykan B. Neuronal autoantibodies in mesial temporal lobe epilepsy with hippocampal sclerosis. J Neurol Neurosurg Psychiatry 2016; 87:684-92. [PMID: 27151964 DOI: 10.1136/jnnp-2016-313146] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/12/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Our aim was to investigate the prevalence of neuronal autoantibodies (NAbs) in a large consecutive series with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) and to elucidate the clinical and laboratory clues for detection of NAbs in this prototype of frequent, drug-resistant epilepsy syndrome. METHODS Consecutive patients diagnosed with MTLE fulfilling the MRI criteria for HS were enrolled. The sera of patients and various control groups (80 subjects) were tested for eight NAbs after ethical approval and signed consents. Brain tissues obtained from surgical specimens were also investigated by immunohistochemical analysis for the presence of inflammatory infiltrates. The features of seropositive versus seronegative groups were compared and binary logistic regression analysis was performed to explore the differentiating variables. RESULTS We found antibodies against antigens, contactin-associated protein-like 2 in 11 patients, uncharacterised voltage-gated potassium channel (VGKC)-complex antigens in four patients, glycine receptor (GLY-R) in 5 patients, N-methyl-d-aspartate receptor in 4 patients and γ-aminobutyric acid receptor A in 1 patient of 111 patients with MTLE-HS and none of the control subjects. The history of status epilepticus, diagnosis of psychosis and positron emission tomography or single-photon emission CT findings in temporal plus extratemporal regions were found significantly more frequently in the seropositive group. Binary logistic regression analysis disclosed that status epilepticus, psychosis and cognitive dysfunction were statistically significant variables to differentiate between the VGKC-complex subgroup versus seronegative group. CONCLUSIONS This first systematic screening study of various NAbs showed 22.5% seropositivity belonging mostly to VGKC-complex antibodies in a large consecutive series of patients with MTLE-HS. Our results indicated a VGKC-complex autoimmunity-related subgroup in the syndrome of MTLE-HS.
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Affiliation(s)
- Ebru Nur Vanli-Yavuz
- Istanbul Faculty of Medicine, Departments of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey Department of Neurology, Koc University, School of Medicine, Istanbul, Turkey
| | - Ece Erdag
- Department of Neuroscience, Istanbul University, Institute of Experimental Medical Research, Istanbul, Turkey
| | - Erdem Tuzun
- Department of Neuroscience, Istanbul University, Institute of Experimental Medical Research, Istanbul, Turkey
| | - Esme Ekizoglu
- Istanbul Faculty of Medicine, Departments of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey Department of Neuroscience, Istanbul University, Institute of Experimental Medical Research, Istanbul, Turkey
| | - Leyla Baysal-Kirac
- Istanbul Faculty of Medicine, Departments of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Canan Ulusoy
- Department of Neuroscience, Istanbul University, Institute of Experimental Medical Research, Istanbul, Turkey
| | - Sian Peach
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Gokcen Gundogdu
- Istanbul Faculty of Medicine, Department of Pathology, Istanbul University, Istanbul, Turkey
| | - Serra Sencer
- Istanbul Faculty of Medicine, Department of Neuroradiology, Istanbul University, Istanbul, Turkey
| | - Altay Sencer
- Istanbul Faculty of Medicine, Department of Neurosurgery, Istanbul University, Istanbul, Turkey
| | - Cem Ismail Kucukali
- Department of Neuroscience, Istanbul University, Institute of Experimental Medical Research, Istanbul, Turkey
| | - Nerses Bebek
- Istanbul Faculty of Medicine, Departments of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Candan Gurses
- Istanbul Faculty of Medicine, Departments of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Aysen Gokyigit
- Istanbul Faculty of Medicine, Departments of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Betul Baykan
- Istanbul Faculty of Medicine, Departments of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
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Yörükoğlu AG, Tahta A, Akçakaya MO, Sabancı PA, Aras Y, Aydoseli A, Dolgun M, Sencer A, Hepgül K. Percutaneous Fully Endoscopic İnterlaminar Approach to the Filum Terminale: A Cadaveric Study. World Neurosurg 2016; 92:402-406. [PMID: 27241095 DOI: 10.1016/j.wneu.2016.05.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 05/18/2016] [Accepted: 05/19/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate the utility, safety, and feasibility of a novel endoscopic technique for the visualization and surgical manipulation of the filum terminale in fresh postmortem adult human cadavers. METHODS The filums from 18 fresh postmortem adult human cadavers were explored with a percutaneous fully endoscopic interlaminar approach. After the filum was identified and the nerve roots were dissected away from it, the filum was cut. A specimen was sent for histopathologic examination. RESULTS In 15 of 18 (83%) cadavers, the filum terminale could be visualized. A specimen for histopathologic examination was obtained from 11 of 15 (73%) visualized filums. Histopathologic examination revealed that 2 of them were fatty filums, 7 were normal filums, and 2 were peripheral nerves. CONCLUSIONS We have described a successful and feasible percutaneous fully endoscopic interlaminar approach to the filum terminale. This technique provides a smaller skin incision, narrow durotomy, and minimal tissue damage. Animal studies are necessary to prove the feasibility and safety of our method before clinical use.
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Affiliation(s)
| | - Alican Tahta
- Department of Neurosurgery, Iğdır State Hospital, Iğdır, Turkey
| | | | - Pulat Akın Sabancı
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Yavuz Aras
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydın Aydoseli
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Müge Dolgun
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Altay Sencer
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Kemal Hepgül
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
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Liu S, Sha Z, Sencer A, Aydoseli A, Bebek N, Abosch A, Henry T, Gurses C, Ince NF. Exploring the time–frequency content of high frequency oscillations for automated identification of seizure onset zone in epilepsy. J Neural Eng 2016; 13:026026. [DOI: 10.1088/1741-2560/13/2/026026] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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41
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Aras Y, Sabanci PA, Izgi N, Boyali O, Ozturk O, Aydoseli A, Ali A, Sencer A, Hepgul K, Unal F, Barlas O. Surgery for Pyogenic Brain Abscess over 30 Years: Evaluation of the Roles of Aspiration and Craniotomy. Turk Neurosurg 2016; 26:39-47. [PMID: 26768867 DOI: 10.5137/1019-5149.jtn.15099-15.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM To evaluate the roles of craniotomy and aspiration in the treatment of pyogenic brain abscess throughout 30 years of computerized tomography. MATERIAL AND METHODS A retrospective study of 224 patients who were surgically treated at Istanbul Medical Faculty, Department of Neurosurgery between 1982 and 2012 was undertaken. The records were analyzed for demographic, clinical and radiological findings, surgical interventions (resection, free-hand aspiration and image-guided aspiration), data regarding abscesses (etiological factors, site, size, number, localization and identified microorganism), corticosteroid and antibiotic usage and complications, and the outcomes were reviewed. RESULTS The male-to-female ratio was 2.2, and the mean age was 26.2±1.25 years. The most common presenting symptom was headache (56.7%), followed by nausea and vomiting (28.5%). Otitis media and mastoiditis were the most common causes of abscess (41.9%), and 44 patients had multiple abscesses. Aerobic gram-positive microorganisms were the most frequently isolated pathogens in culture (51.5%). Primary surgical interventions were as follows: craniotomy and resection (38.8%), free-hand aspiration (49.1%) and image-guided aspiration (12.1%). The aspiration-to-resection ratio was 1.36 (64/47) in the first decade, 2.94 (50/17) in the second decade and 1 (23/23) in the last decade. Age, level of consciousness at the time of admission and potent corticosteroid usage were found to be significantly associated with mortality (p=0.001, p≤0.001 and p=0,038, respectively). The total morbidity and mortality ratios were 4.9% and 9.8%, respectively. Seizures were more common in patients of craniotomy group (p=0.023). CONCLUSION Treatment of pyogenic brain abscess remains challenging, despite advances in surgical and imaging technology, and craniotomy retains a significant role in surgical treatment.
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Affiliation(s)
- Yavuz Aras
- Istanbul University, Istanbul Medical Faculty, Department of Neurosurgery, Istanbul, Turkey
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42
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Akcakaya MO, Aydoseli A, Aras Y, Sabanci PA, Barburoglu M, Alkir G, Sencer A, Sencer S, Aydin K, Kiris T, Hepgul K, Unal OF, Barlas O, Izgi N. Clinical course of nontraumatic nonaneurysmal subarachnoid hemorrhage: a single institution experience over 10 years and review of the contemporary literature. Turk Neurosurg 2016; 27:732-742. [DOI: 10.5137/1019-5149.jtn.18359-16.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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43
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Meral R, Gurdal N, Kemikler G, Okutan M, Sahin D, Ahmedova A, Altun M, Sencer A, Uzum A, Hatipoglu E. Radiation Dose to Hippocampus With Increasing Planning Target Volume in Patients With Pituitary Adenoma Treated With Hypofractionated Radiation Therapy. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Akçakaya MO, Aras Y, İzgi N, Gayretli Ö, Sabancı PA, Aydoseli A, Gürses İA, Sencer A, Öztürk A, Hepgül K. Fully endoscopic supraorbital keyhole approach to the anterior cranial base: A cadaveric study. J Neurosci Rural Pract 2015; 6:361-8. [PMID: 26167020 PMCID: PMC4481791 DOI: 10.4103/0976-3147.154568] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
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 ± 6.1 mm (71–93 mm); internal carotid artery (ICA) bifurcation as 74.7 ± 6.0 mm (66–84 mm) and the basilar tip as 94.9 ± 7.0 mm (87–111 mm). The mean diameter of the optic canal was 7.4 ± 1.3 mm (6–11 mm), whereas the mean diameter of diaphragma sellae was measured as 8.4 ± 1.1 mm (7–10 mm). Conclusions: The results of this study showed that the anterior and medial aspects of the anterior cranial fossa can be visualized properly. Dissection of the ipsilateral arteries of Circle of Willis can be performed easily using an endoscopic supraorbital keyhole approach.
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Affiliation(s)
- Mehmet Osman Akçakaya
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Yavuz Aras
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Nail İzgi
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Özcan Gayretli
- Department of Anatomy, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Pulat Akın Sabancı
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydın Aydoseli
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - İlke Ali Gürses
- Department of Anatomy, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Altay Sencer
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Adnan Öztürk
- Department of Anatomy, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Kemal Hepgül
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
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Ali A, Basaran B, Tanirgan G, Aydoseli A, Sabanci PA, Sencer A, Telci L, Akinci IO. Metabolic changes and factors influencing base deficit in infants undergoing craniosynostosis surgery: a retrospective study. Acta Neurochir (Wien) 2015; 157:1197-204; discussion 1204. [PMID: 25967890 DOI: 10.1007/s00701-015-2441-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 04/28/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSION 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.
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Affiliation(s)
- Achmet Ali
- Istanbul Faculty of Medicine, Department of Anesthesiology and Reanimation Fatih, Istanbul University, Istanbul, Turkey
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Aydoseli A, Aras Y, Sabancı A, Keskin M, Balik E, Onder S, Sencer A, Izgi N, Tahta A. Use of Antifibrotics to Prevent Ventriculoperitoneal Shunt Complications Due to Intra-abdominal Fibrosis: Experimental Study in a Rat Model. J Neurol Surg A Cent Eur Neurosurg 2015; 76:219-23. [DOI: 10.1055/s-0034-1389369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Aydın Aydoseli
- Department of Neurosurgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Yavuz Aras
- Department of Neurosurgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Akın Sabancı
- Department of Neurosurgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Metin Keskin
- Department of General Surgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Emre Balik
- Department of General Surgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Semen Onder
- Department of Pathology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Altay Sencer
- Department of Neurosurgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Nail Izgi
- Department of Neurosurgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Alican Tahta
- Department of Neurosurgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
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Aydoseli A, Akcakaya MO, Aras Y, Sabanci PA, Unal TC, Sencer A, Hepgul K, Unal OF, Barlas O, Izgi N. Neuronavigation-assisted percutaneous balloon compression for the treatment of trigeminal neuralgia: The technique and short-term clinical results. Br J Neurosurg 2015; 29:552-8. [PMID: 25807330 DOI: 10.3109/02688697.2015.1019418] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Percutaneous balloon compression (PBC) has been widely used in the treatment of trigeminal neuralgia. However, this technique has a steep learning curve and significant complications were reported that were related to foramen ovale puncturing. The aim of this study was to evaluate the clinical results of a small patient group who underwent neuronavigation-assisted PBC. METHODS An intraoperative computed tomography (CT) device (CereTom, Neurologica, Danvers, MA/USA) was used to obtain CT scans with 2-mm slice thicknesses. The data were transferred to a neuronavigation system planning station (BrainLab, Feldkirchen, Germany). A soft touch registration system was used for image registration. With the image guidance, a trajectory was defined and the foramen ovale was cannulated using neuronavigation and Hartel's landmarks. RESULTS Sixteen procedures were performed on 13 patients (4 female and 9 male) without complications. The total length of the procedure was not more than 57 min in all instances. CONCLUSIONS We believe that image-guided neuronavigation is useful for neurosurgeons who are at the beginning of their PBC learning curve. It may also be an alternative for particular patients with significant anatomic variations that result in an unsuccessful foramen ovale puncture.
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Affiliation(s)
- Aydin Aydoseli
- a Department of Neurosurgery , Istanbul School of Medicine, Istanbul University , Istanbul , Turkey
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48
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Sencer A, Yorukoglu AG, Akcakaya MO, Aras Y, Aydoseli A, Boyali O, Sencan F, Sabanci PA, Gomleksiz C, Imer M, Kiris T, Hepgul K, Unal OF, Izgi N, Canbolat AT. Fully Endoscopic Interlaminar and Transforaminal Lumbar Discectomy: Short-Term Clinical Results of 163 Surgically Treated Patients. World Neurosurg 2014; 82:884-90. [DOI: 10.1016/j.wneu.2014.05.032] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 12/07/2013] [Accepted: 05/29/2014] [Indexed: 10/25/2022]
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Sencer A, Akcakaya MO, Basaran B, Yorukoglu AG, Aydoseli A, Aras Y, Sencan F, Satana B, Aslan I, Unal OF, Izgi N, Canbolat A. Unilateral endoscopic optic nerve decompression for idiopathic intracranial hypertension: a series of 10 patients. World Neurosurg 2014; 82:745-50. [PMID: 24704940 DOI: 10.1016/j.wneu.2014.03.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 03/28/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Several surgical treatment modalities, including lumboperitoneal or ventriculoperitoneal shunt surgery, subtemporal decompression, endovascular venous sinus stenting, optic nerve decompression (OND), were used in the management of idiopathic intracranial hypertension (IIH). Each surgical technique has different advantages and disadvantages. Endoscopic OND is rarely used in the management of IIH. There are only four reported cases. The aim of this study is to describe the surgical results of patients treated with this less invasive surgical technique. METHODS A series of 10 consecutive cases of unilateral OND was reviewed. Between December 2008 and December 2012 these patients underwent the endoscopic approach without nerve sheath opening. Presenting symptoms, neurological examination findings, magnetic resonance venography imaging results, fundoscopic and visual acuity examination findings, and automated perimetry test results were recorded. Perioperative results, including complications and length of hospital stay, were evaluated. Findings at follow-up evaluations were also recorded. RESULTS This report is the first series of unilateral OND performed using the endoscopic approach. The mean patient age was 34.1 years (range, 9-49 years); there were nine female and one male patients. Visual impairment was the main symptom in this patient group, whereas headache was a secondary complaint. The patients were first managed with medical treatment for at least 3 months. Unilateral endoscopic OND was performed on the side with the most visual failure. Mean follow-up was 28.4 months (range, 8-55 months). The visual field defects and visual acuity improved in eight of nine patients, whereas papilloedema improved in seven of nine patients. Also headaches resolved in four of seven patients. There were no complications in this relatively small series. CONCLUSIONS The surgical treatment of IIH by using the unilateral endoscopic OND technique is a safe and effective method in the hands of experienced surgeons with advanced endoscopic skills. A collaboration with the ophthalmology team is needed for the follow-up. Further studies with larger patient numbers is needed to compare unilateral endoscopic OND technique with the current techniques used in the surgical management of IIH.
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Affiliation(s)
- Altay Sencer
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Osman Akcakaya
- Department of Neurosurgery, Taksim Training and Research Hospital, Istanbul, Turkey.
| | - Bora Basaran
- Department of Otorhinolaryngology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Aydin Aydoseli
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Yavuz Aras
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Fahir Sencan
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Banu Satana
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey; Department of Ophthalmology, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Ismet Aslan
- Department of Otorhinolaryngology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Omer Faruk Unal
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Nail Izgi
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Ali Canbolat
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
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Aydin K, Arat A, Sencer S, Hakyemez B, Barburoglu M, Sencer A, İzgi N. Treatment of ruptured blood blister-like aneurysms with flow diverter SILK stents. J Neurointerv Surg 2014; 7:202-9. [DOI: 10.1136/neurintsurg-2013-011090] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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