Publications by authors named "Agahan Unlu"

28 Publications

  • Page 1 of 1

Endoscopic Transnasal Skull Base Surgery in Pediatric Patients.

J Neurol Surg B Skull Base 2020 Oct 18;81(5):515-525. Epub 2019 Jun 18.

Department of Neurosurgery, Ankara University, Ankara, Turkey.

 In pediatric patients, endoscopic transnasal surgery (ETNS) poses challenges because of the small size of the developing skull and narrow endonasal corridors.  This study aimed to evaluate the efficacy of ETNS in children by assessing our experience of endoscopic skull base surgery.  All pediatric patients (  = 54) who were eligible for surgery using only the endonasal endoscopic approach at our tertiary center between 2012 and 2018 were included in this study. The surgeries were performed simultaneously by an endoscopic skull base team of neurosurgeons and otolaryngologists. Hormonal analyses were conducted before and after surgery in all patients with sellar/parasellar lesions. Patients older than 8 years underwent smell and visual testing.  In the 54 patients aged 1 to 17 years who underwent surgery, craniopharyngioma was the most common pathology (29.6%), followed by pituitary adenoma (22.2%). Gross total resection was achieved in 33 (76.7%) of 41 patients who underwent surgery because of the presence of tumors. All visual deficits improved, although one patient sustained olfactory deterioration. Sixteen (29.6%) patients presented with complications such as transient diabetes insipidus and temporary visual loss.  Despite anatomy-related challenges in children, adequate results can be achieved with high rates of success, and the functional and anatomical integrity of the developing skull and nose of children can be preserved. In pediatric patients, ETNS is a safe and effective option for addressing various lesions along the skull base.
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http://dx.doi.org/10.1055/s-0039-1692641DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7591368PMC
October 2020

Repeat endoscopic third ventriculostomy success rate according to ventriculostoma closure patterns in children.

Childs Nerv Syst 2021 Mar 31;37(3):913-917. Epub 2020 Oct 31.

Department of Neurosurgery, Ankara University, Sihhiye, 06100, Ankara, Turkey.

Purpose: This study aimed to examine the success rate of repeat endoscopic third ventriculostomy (redo-ETV) according to pattern of ventriculostoma closure based on observations in 97 paediatric redo-ETV patients.

Methods: Clinical data and intraoperative video recordings of 97 paediatric hydrocephalus patients who underwent redo-ETV due to ventriculostoma closure at two institutions were retrospectively analysed. We excluded patients with a history of intraventricular haemorrhage, cerebrospinal fluid (CSF) infection or CSF shunt surgery and those with incompletely penetrated membranes during the initial ETV.

Results: Verification of ventriculostoma closure was confirmed with cine phase-contrast magnetic resonance imaging and classified into 3 types: type 1, total closure of the ventriculostoma by gliosis or scar tissue that results in a non-translucent/opaque third ventricle floor; type 2, narrowing/closure of the ventriculostoma by newly formed translucent/semi-transparent membranes; and type 3, presence of a patent ventriculostoma orifice with CSF flow blockage by newly formed reactive membranes or arachnoidal webs in the basal cisterns. The overall success rate of redo-ETV was 37.1%. The success rates of redo-ETV according to closure type were 25% for type 1, 43.6% for type 2 and 38.2% for type 3. The frequency of type 1 ventriculostoma closure was significantly higher in patients with myelomeningocele-related hydrocephalus.

Conclusion: For patients with ventriculostoma closure after ETV, reopening of the stoma can be performed. Our findings regarding the frequencies of ventriculostoma closure types and the success rate of redo-ETV in paediatric patients according to ventriculostoma closure type are preliminary and should be verified by future studies.
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http://dx.doi.org/10.1007/s00381-020-04949-0DOI Listing
March 2021

Anterior Subcutaneous Transposition With Expanded Polytetrafluoroethylene (ASTEP) for Cubital Tunnel Syndrome: Technical Note.

Oper Neurosurg (Hagerstown) 2020 09;19(4):E337-E342

Department of Neurological Surgery, Indiana University, Indianapolis, Indiana.

Background: Ulnar nerve entrapment neuropathy at the elbow is the most common upper-extremity entrapment neuropathy after carpal tunnel syndrome. Surgical treatment can be complicated by perineural scarring and fibrosis, which may lead to recurrent symptoms. Expanded polytetrafluoroethylene (ePTFE) is a synthetic polymer with antiadhesive properties.

Objective: To introduce the operative technique and outcomes of anterior subcutaneous transposition with ePTFE (ASTEP) in primary and recurrent cubital tunnel neuropathy.

Methods: We studied 14 adult patients (11 men, 3 women; mean age, 45 yr) with cubital tunnel neuropathy (10 primary, 4 revision) who underwent surgery with the ASTEP technique between January 2008 and May 2018. Pain, numbness in the fourth/fifth fingers, and weakness of the intrinsic hand muscles were the most common presenting symptoms. Surgical outcomes were assessed using the modified McGowan and Wilson-Krout criteria.

Results: The average (± standard deviation) preoperative symptom duration was 12.1 ± 5.2 mo (McGowan Grade 1, n = 5; Grade 2, n = 6; Grade 3, n = 3). No intraoperative or postoperative complications were observed with the ASTEP technique. Postoperative follow-up ranged from 9 mo to 7 yr (mean, 4.3 yr). All 14 patients experienced improvement in or complete resolution of their symptoms after this unique intervention.

Conclusion: Our novel technique of anterior transposition of the ulnar nerve with ePTFE was safe and highly effective in treating primary and recurrent ulnar nerve entrapment neuropathy at the elbow and represents an alternative to the current techniques.
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http://dx.doi.org/10.1093/ons/opaa081DOI Listing
September 2020

The Effect of Phenyramidol on Neural Development in Early Chicken Embryo Model.

Turk Neurosurg 2019 ;29(6):851-855

Ankara University, School of Medicine, Department of Neurosurgery, Ankara, Turkey.

Aim: To investigate the effects of Phenyramidol (Phe) on neural development in an early chicken embryo model.

Material And Methods: Sixty fertile non-pathogenic Super Nick eggs were incubated for 24 hours (h) and divided into four groups of 15 eggs each. Phe was administrated through the sub-blastoderm, and the eggs were incubated for another 24 h. All eggs were opened after 48 h of incubation, and the embryos were evaluated morphologically and histopathologically.

Results: In Group 1 (control group), none exhibited neural tube defects (NTDs) (0%), 1 (6.6%) was undeveloped; in Group 2 (low dosages), 1 did not develop (6.6%); in Group 3 (normal dosages), 2 (13.4%) had NTDs, 1 (6.6%) was undeveloped; in Group 4 (high dosages), 5 (33.3%) had NTDs, 2 (13.3%) were undeveloped.

Conclusion: In light of the results, it was determined that the use of increasing doses of Phe led to defects in midline closure in early chicken embryos. This is the first report in the literature on Phe used in an early chicken embryo model.
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http://dx.doi.org/10.5137/1019-5149.JTN.26158-19.1DOI Listing
February 2020

Marking Basilar Artery Using Neuronavigation During Endoscopic Third Ventriculostomy: A Clinical Study.

Turk Neurosurg 2020 ;30(1):23-29

Ankara University School of Medicine, Department of Neurosurgery, Ankara, Turkey.

Aim: To evaluate the efficacy of using a neuronavigation system for demonstrating the relationship between the basilar artery (BA) and ventricular floor during endoscopic third ventriculostomy (ETV).

Material And Methods: Records of 28 patients (16 females and 12 males) diagnosed with obstructive hydrocephalus who had undergone a neuroendoscopic procedure were retrospectively examined. Patient age ranged from 1 to 76 years (median 24.46 years). The BA was marked with using the neuronavigation system in all cases to visualise its relationship to the floor of the third ventricle in real time.

Results: ETV was successfully performed in 28 patients with obstructive hydrocephalus. Of these, 13 (46.4%) patients had a thickened tuber cinereum (TC) membrane and 3 (10.7%) showed lateralization of the BA under the ventricular floor. No contact with the BA or related complications (e.g., major bleeding) was encountered with BA marking by using neuronavigation.

Conclusion: Even though thickening of the TC membrane and/or displacement of the BA might be seen otherwise, we describe a new method that combines marking the BA and using neuronavigation to provide greater safety in the area where the ventriculostomy will be performed. This permits clearer orientation for the surgeon which significantly contributes to minimizing surgical morbidity.
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http://dx.doi.org/10.5137/1019-5149.JTN.25698-19.1DOI Listing
July 2020

Supraorbital Keyhole Approach: Lessons Learned from 106 Operative Cases.

World Neurosurg 2019 Jan 17. Epub 2019 Jan 17.

Department of Neurosurgery, School of Medicine, Ankara University, Ibn-i Sina Hospital, Ankara, Turkey.

Objective: The supraorbital keyhole approach through an eyebrow incision has been a potentially less invasive approach as an alternative to the standard pterional craniotomy. We aimed to review procedures for anterior and middle cranial fossa lesions and identify lessons learned from addressing various pathologies through this approach.

Methods: We retrospectively reviewed 106 consecutive patients who underwent this approach. We documented patients' age, sex, pathology, clinical results, extent of tumor resection, complications, use of endoscope, and cosmetic results.

Results: Our series addressed a variety of pathologies. Male patients accounted for 55% of the cohort and mean age was 51.7 (2-79) years. Notably, 52% of patients underwent resection of extra-axial masses. Gross total resection was achieved in 74.4% of intra-axial lesions according to postoperative imaging. Two (1.9%) patients developed transient ptosis. One (0.9%) patient developed an allergic reaction to titanium. No cerebrospinal fluid fistula or rhinorrhea occurred. Three patients developed temporary diabetes insipidus after resection of parasellar lesions (2 craniopharyngiomas and 1 pituitary adenoma). In 14 patients with olfactory groove meningiomas, 6 (42.8%) suffered from absence or diminished olfaction postoperatively, and 2 (14.2%) developed postoperative anosmia. Five (38.5%) patients underwent a subsequent resection of recurrent glial tumors. Four weeks postoperatively, 95% of patients demonstrated acceptable cosmetic results. Cosmetic results for 6 (5%) patients were unavailable.

Conclusions: The supraorbital keyhole approach may be safely used for various lesions within the anterior and middle cranial fossa. The effectiveness and limitations of this approach and possible complications are discussed. This is a valuable approach for selected patients.
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http://dx.doi.org/10.1016/j.wneu.2018.12.188DOI Listing
January 2019

Single-Center Surgical Experience of the Treatment of Craniopharyngiomas With Emphasis on the Operative Approach: Endoscopic Endonasal and Open Microscopic Transcranial Approaches.

J Craniofac Surg 2018 Sep;29(6):e572-e578

Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara.

This study aimed to report the authors' single-center clinical experience about craniopharyngiomas and discuss surgical outcomes of these patients according to the type of surgical approach (endoscopic endonasal or open microscopic transcranial approach).Twenty-four patients diagnosed with craniopharyngiomas between May 2013 and April 2017 were considered for inclusion. The patients were divided into 2 groups according to the surgical approach (open transcranial microscopic approach [group A] and endoscopic endonasal approach [group B]). These groups were compared in terms of postoperative surgical outcome scores (extent of tumor removal, visual deficit, hydrocephalus, metabolic disorders, and Glasgow coma scale) and hospitalization interval.There was no patient of mortality in both groups. In this study, 4 of the 13 patients in group A and 9 of the 11 patients in group B underwent gross total resection. However, 1 patient in group B underwent repair because of cerebrospinal fluid leakage postoperatively. In addition, 1 patient in group A had a wound healing problem postoperatively. The postoperative outcome scores were 9.5 in group A and 11.5 in group B. The hospitalization interval in group A (range, 7-9 days) was longer than that in group B (range, 5-7 days).The endoscopic endonasal approach should be considered the first-line surgical treatment modality in patients with a preliminary diagnosis of craniopharyngioma in terms of low complication risk, minimal invasiveness, and better outcome scores. Open microscopic transcranial procedures may be combined with this approach in a single session for challenging cases.
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http://dx.doi.org/10.1097/SCS.0000000000004592DOI Listing
September 2018

Endoscopic removal of a suprasellar dermoid cyst in a pediatric patient: a case report and review of the literature.

Childs Nerv Syst 2018 08 20;34(8):1583-1587. Epub 2018 Mar 20.

Ibni Sina Hospital, Department of Neurosurgery, Ankara University School of Medicine, Sihhiye, 06100, Ankara, Turkey.

Introduction: Dermoid cysts (DCs) are unusual benign congenital intracranial tumors that typicallyarise in the midline and form as a result of abnormal sequestration of ectodermal cells during neural tubeformation. In all age groups, endoscopic approaches are preferable for the removal of sellar lesions. A 6-year-old girl with recurrent meningitis underwent endoscopic endonasal surgery forsellar DC.

Conclusion: To the best of our knowledge, we present the first case of a suprasellar DC in a pediatric patient that was removed endoscopically.
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http://dx.doi.org/10.1007/s00381-018-3777-yDOI Listing
August 2018

The effect of magnetic resonance imaging on neural tube development in an early chicken embryo model.

Childs Nerv Syst 2018 05 1;34(5):933-938. Epub 2018 Feb 1.

Department of Neurosurgery, Ibni Sina Hospital, Ankara University, Ankara, Turkey.

Purpose: We aimed to determine whether varying the magnetic field during magnetic resonance imaging would affect the development of chicken embryos and neural tube defects.

Methods: Following incubation for 24 h, we exposed chicken embryos to varying magnetic fields for 10 min to assess the impact on development. Three magnetic resonance imaging devices were used, and the eggs were divided into four groups: group 1 is exposed to 1 T, group 2 is exposed to 1.5 T, group 3 is exposed to 3 T, and group 4, control group, was not exposed to magnetic field. After MRI exposure, all embryos were again put inside incubator to complete 48 h. "The new technique" was used to open eggs, a stereomicroscope was used for the examination of magnified external morphology, and each embryo was examined according to the Hamburger and Hamilton chicken embryo stages. Embryos who had delayed stages of development are considered growth retarded. Growth retardation criteria do not include small for stage.

Results: Compared with embryos not exposed to a magnetic field, there was a statistically significant increase in the incidence of neural tube closure defects and growth retardation in the embryos exposed to magnetic fields (p < 0.05). However, although the incidence of neural tube closure defects was expected to increase as exposure (tesla level) increased, we found a higher rate of defects in the 1.5-T group compared with the 3-T group. By contrast, the highest incidence of growth retardation was in the 3-T group, which was consistent with our expectation that growth retardation would be more likely as tesla level increased.

Conclusions: We therefore conclude that the use of magnetic resonance imaging as a diagnostic tool can result in midline closure defects and growth retardation in chicken embryos. We hypothesize that this may also be true for human embryos exposed to MRI. If a pregnant individual is to take an MRI scan, as for lumbar disc disease or any other any other reason, our results indicate that consideration should be given to an avoidance of MRI during pregnancy.
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http://dx.doi.org/10.1007/s00381-018-3734-9DOI Listing
May 2018

FATAL RUPTURE OF DISSECTING ANTERIOR INFERIOR CEREBELLAR ARTERY ANEURYSM AS AN UNEXPECTED COMPLICATION AFTER ANTERIOR SKULL BASE SURGERY: A CASE REPORT.

Turk Neurosurg 2018 13;28(4):675-677. Epub 2016 Oct 13.

Ankara University.

Aneurysm of the anterior inferior cerebellar artery (AICA) is a very rare entity and the manifestation and manipulation of such aneurysms remain contentious. In this paper, we report a case where a successful surgery for an olfactory groove meningioma was performed and the patient discharged but readmitted to hospital with loss of consciousness and subsequently passed away three hours after re-admission. The patient was diagnosed with subarachnoid hemorrhage. The cause of the fatal subarachnoid hemorrhage was rupture of a new onsetting AICA dissecting aneurysm which had provided neither clinical nor radiological signs before the operation. We discuss the possible causes of the formation of such aneurysm.
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http://dx.doi.org/10.5137/1019-5149.JTN.18758-16.0DOI Listing
October 2016

Early Endoscopic Ventricular Irrigation for the Treatment of Neonatal Posthemorrhagic Hydrocephalus: A Feasible Treatment Option or Not? A Multicenter Study.

Turk Neurosurg 2018 ;28(1):137-141

Kocaeli University, School of Medicine, Department of Neurosurgery, Kocaeli, Turkey.

Aim: Neonatal intraventricular hemorrhage (IVH) usually results in posthemorrhagic hydrocephalus (PHH). This multicenter study describes the approach of early neuroendoscopic ventricular irrigation for the treatment of IVH/PHH and compares the results with the cases that have been initially treated only with conventional temporary cerebrospinal fluid (CSF) diversion techniques.

Material And Methods: The data of 74 neonatal PHH cases, that have been treated at three pediatric neurosurgery centers, were retrospectively analyzed. 23 neonates with PHH underwent early endoscopic ventricular irrigation (Group-A). 29 neonates were initially treated with conventional methods (Group-B). 22 neonates underwent ventriculosubgaleal shunt placement (Group-C). Complications, shunt dependency rates, incidence of multiloculated hydrocephalus and incidence of CSF infection were evaluated and compared retrospectively.

Results: Group-A, Group-B and Group-C cases did not differ significantly regarding gestational age and birth weight. In Group-A, 60.8% of the patients required a later shunt insertion, as compared with 93.1% of the cases in Group-B and 77.2% of the cases in Group-C. Group-A patients were also associated with significantly fewer CSF infections as well as significantly lower incidence for multiloculated hydrocephalus development as compared with Group-B and Group-C.

Conclusion: Early removal of intraventricular blood degradation products and residual hematoma via neuroendoscopic ventricular irrigation is feasible and safe for the treatment of PHH in neonates with IVH. Neuroendoscopic technique seems to offer significantly lower shunt rates and fewer complications such as infection and development of multiloculated hydrocephalus in those cases.
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http://dx.doi.org/10.5137/1019-5149.JTN.18677-16.0DOI Listing
June 2018

Does Shunt Selection Affect the Rate of Early Shunt Complications in Neonatal Myelomeningocele-Associated Hydrocephalus? A Multi-Center Study.

Turk Neurosurg 2018 ;28(2):303-306

Ankara University, Faculty of Medicine, Department of Neurosurgery, Ankara, Turkey.

Aim: To evaluate the effect of shunt selection on the rate of shunt revision due to early shunt complications in neonatal myelomeningocele-associated hydrocephalus.

Material And Methods: The data of 157 neonatal myelomeningocele cases in three pediatric neurosurgery centers (Ankara University, Kocaeli University, Selcuk University) who underwent shunt surgery at the time of myelomeningocele repair between 2000 and 2014 were retrospectively analyzed. Clinical features of the patients, shunt types, and early shunt complications within the first three months were recorded. The patients were classified according to several features of the shunt systems, such as the valve type, valve size/contour and catheter type.

Results: Of all patients, 71 (45.2%) underwent early shunt revision surgery due to various complications. Mechanical complications were the most frequent cause of shunt failure, followed by infection. There was no significant difference among the valve types. Also, no significant difference was observed among the catheter types. Only valve contour/size (contoured regular/ultra-small/burr-hole/ cylindrical/neonatal) seemed to significantly affect the rate of early complications. The patients with neonatal-design valves or ultrasmall valves had significantly less complications, such as poor wound-healing, wound-dehiscence, cerebrospinal fluid leak or shunt exposure. The infection rate secondary to these complications was found to be lower.

Conclusion: Myelomeningocele patients with prominent hydrocephalus frequently have a friable skin, due to reduced macrocrania-related subcutaneous tissues. Small-sized (neonatal-design or ultra-small) valves may significantly reduce the early shunt complication rate among this population.
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http://dx.doi.org/10.5137/1019-5149.JTN.18547-16.1DOI Listing
July 2018

Fahr's Syndrome Associated with Multiple Intracranial Aneurysms: A Case Report.

Turk Neurosurg 2016;26(4):643-5

Ankara University, School of Medicine, Department of Neurosurgery, Ankara, Turkey.

Fahr's Syndrome is characterized by the presence of intracerebral, bilateral and symmetrical calcifications located in bilateral basal ganglia, thalamus, and cerebellum. The etiology is not exactly known. The authors reported a very rare case who had Fahr's Syndrome and intracerebral aneurysms simultaneously. The patient was female and presented with headache. Her examinations revealed aneurysms on the middle cerebral artery, internal carotid artery and ophthalmic artery. That is the first case reported in the literature having multiple intracranial aneurysms and Fahr's Syndrome together.
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http://dx.doi.org/10.5137/1019-5149.JTN.8574-13.0DOI Listing
December 2016

Targeting Apoptosis Through Foxp1, and N-cadherin with Glatiramer Acetate in Chick Embryos During Neural Tube Development.

Turk Neurosurg 2016;26(4):586-94

Uludag University, Faculty of Medicine, Department of Neurosurgery, Bursa, Turkey.

Aim: To demonstrate the effect of glatiramer acetate (GA) in chick embryos on neural tube (NT) development, and to explore its effects of Foxp1, apoptosis, and N-cadherin.

Material And Methods: One hundred fertile, specific pathogen free eggs were divided into 5 groups for this study. The eggshell was windowed specifically at 24 hours of incubation. The embryos in Group 1 (n=20) were treated with 10 μl physiological saline; in Group 2 the embryos (n=20) were given 10 μl GA (equal to daily human therapeutic dose); 20 μl GA (equal to twice daily human therapeutic dose) was injected to embryos in Group 3 (n=20); in Group 4 and 5, 30 μl and 40 μl GA were administered to the embryos (n=20) (equal to x3 and x4 daily human therapeutic dose, respectively). Each egg was re-incubated for 24 hours more. Then, histological and immunohistochemical evaluation of the subjects were done.

Results: The embryos with NT defect showed FOXP1 expression without N- cadherin or staining with N-cadherin in another location in our study. We interpreted this result as GA leading to an NT closure defect by increasing FOXP expression. Moreover, we also showed the reverse relation between FOXP1 and N-cadherin at the immunohistochemical level for the first time.

Conclusion: GA affects the spinal cord development through FOXP in the chick embryo model at high doses.
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http://dx.doi.org/10.5137/1019-5149.JTN.14518-15.3DOI Listing
December 2016

Retroaortic Variant of Reverse Horseshoe Kidney With Butterfly Vertebrae Presenting as Neurogenic Bladder.

Urology 2016 Sep 6;95:e1-2. Epub 2016 Jun 6.

Department of Pediatric Urology, School of Medicine, Ankara University, Ankara, Turkey.

Horseshoe kidney is a relatively common congenital anomaly. In 95% of the cases, lower poles are connected to each other. In a small subset, an isthmus connects both upper poles (reverse horseshoe kidney). Almost always, the fusion of kidney poles occurs anterior to the aorta and vena cava. The fusion of renal poles posterior to both aorta and vena cava is extremely rare. Herein, we present a case with multiple rare congenital anomalies-retroaortic variant of reverse horseshoe kidney, retroaortic left renal vein, and butterfly vertebrae.
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http://dx.doi.org/10.1016/j.urology.2016.05.050DOI Listing
September 2016

The Effect of Levetiracetam on Closure of the Midline in Early Chicken Embryos.

Turk Neurosurg 2015 ;25(5):681-4

Ankara University, School of Medicine, Department of Neurosurgery, Ankara, Turkey.

Aim: Genetic predisposition and some environmental factors play an important role in the development of neural tube defects. Levetiracetam is a new drug that has been approved in the treatment of partial seizures. We aimed in this study to determine the effect of levetiracetam on chick embryos.

Material And Methods: One hundred and sixty fertile non-pathogenic Super Nick eggs were incubated for 24 hours and were divided into four groups of 40 eggs each. Levetiracetam was administered via the sub-blastodermic route. The eggs were incubated for another 24 hours. All eggs were opened at the 48th hour, and the embryos were evaluated morphologically and histopathologically.

Results: The effects of levetiracetam on the embryo were correlated with the dose of levetiracetam. In the light of the results, it was determined that the use of increasing doses of levetiracetam led to defects of midline closure in early chicken embryos.

Conclusion: Levetiracetam, a new antiepileptic drug that is effective especially on calcium ion concentration, leads to defects in midline closure in embryos in a dose-dependent manner. Further studies are needed to show the mechanism of embryonic damage and the mechanisms of its teratogenous effects associated with genetic and environmental factors.
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http://dx.doi.org/10.5137/1019-5149.JTN.8514-13.4DOI Listing
May 2016

Pneumocephalus after endoscopic odontoidectomy in a pediatric patient: the lesson learned.

Childs Nerv Syst 2015 Sep 8;31(9):1595-9. Epub 2015 May 8.

School of Medicine, Department of Neurosurgery, Ankara University, 06100, Sihhiye, Ankara, Turkey,

Introduction: Postoperative pneumocephalus is an unexpected condition after endoscopic odontoidectomy surgery.

Case: We present the first case of pneumocephalus after odontoidectomy in a pediatric patient. The clinical presentation, radiological findings, and surgical procedures are described with related pathophysiology.

Conclusion: We outline the key for management of a rare intracranial air entrapment case after an endoscopic odontoidectomy surgery in a pediatric patient and the measures taken to prevent its occurrence in the future.
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http://dx.doi.org/10.1007/s00381-015-2740-4DOI Listing
September 2015

A rare and unexpected clinical progress and location on a primary extradural spinal hydatid cyst in a pediatric patient: a case report.

Childs Nerv Syst 2015 Aug 1;31(8):1407-11. Epub 2015 May 1.

Department of Neurosurgery, School of Medicine, Ankara University, Sihhiye, 06100, Ankara, Turkey.

Background: Involvement of spine in patients with hydatid disease (HD) is less than 1% and primary intra-spinal extradural HD is extremely rare. Although this disease is introduced as benign pathology according to its clinical presentation and biological behavior, intraoperative rupture of the cyst may aggravate the patients' outcome in the long-term especially in pediatric patient population.

Case Presentation: We report a 9-year-old girl who presented a progressive neurological deterioration due to an enlargement of a ventrally located extradural hydatid cyst within the thoracic spinal canal. Total removal of the cyst was achieved by preserving the capsule integrity for preventing potential seeding. Our preoperative initial diagnosis based on the radiological findings was confirmed as cyst hydatid histopathologically.

Conclusion: Cyst hydatid should be considered in the differential diagnosis of the presence of homogenous cystic lesions with regular shape inside the spinal canal especially in patients from endemic region. To our knowledge, this pediatric patient is the first case of cyst hydatid located ventral side of the spinal cord extradurally located inside the spinal canal showing no extension.
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http://dx.doi.org/10.1007/s00381-015-2728-0DOI Listing
August 2015

Orbital eosinophilic granuloma in a child: a case report.

Turk Neurosurg 2013 ;23(4):575-7

Ankara University, Faculty of Medicine, Department of Neurosurgery, Ankara, Turkey.

Eosinophilic granuloma is a rare disease belonging to the Langerhans' cell histiocytosis group. It accounts for only 1% of all tumor-like lesions of bone. A 6-year-old girl presented with proptosis, and a mass and pain in her right eye. Cranial computerized tomography and magnetic resonance imaging revealed a mass in her right orbital area. The patient was operated through a right frontotemporal craniotomy and orbitozygomatic osteotomy. The tumour was totally removed. The postoperative course was uneventful. Histopathological examination revealed a diagnosis of eosinophilic granuloma with typical Langerhans cells and eosinophylic leucocyte infiltration. We report an orbital eosinophilic granuloma case, which is rarely seen, and discuss its clinical and pathological features.
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http://dx.doi.org/10.5137/1019-5149.JTN.6026-12.0DOI Listing
May 2014

Olfactory functions after transsphenoidal pituitary surgery: endoscopic versus microscopic approach.

Laryngoscope 2013 Sep 8;123(9):2112-9. Epub 2013 Jul 8.

Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara, Turkey.

Objectives/hypothesis: Olfactory disturbances could be observed following transsphenoidal pituitary surgeries. To our knowledge, no previous comparative studies on olfactory functions after transsphenoidal endoscopic and microscopic approaches have been performed.

Study Design: Prospective study comparing olfactory functions between endoscopic and microscopic transsphenoidal pituitary surgery.

Method: Twenty-five patients operated on with the endoscopic approach and 25 patients operated on with the microscopic transsphenoidal approach have been evaluated. The Smell Diskettes Olfaction Test was used during the preoperative period, 1 month after the operation, and 6 months after the operation. In addition, the relationship between intraoperative cerebrospinal fluid leakage from the pituitary and postoperative synechiae formation with olfaction system was evaluated. The results were analyzed using the Friedman test, Mann-Whitney test, and Chi-Square test.

Results: In the endoscopic group, there were two hyposmic patients and no anosmic patients. In the microscopic group, there were 13 hyposmic patients and five anosmic patients. The data was statistically different between both groups (P <0.05). Cerebrospinal fluid leakage was observed in nine patients in the endoscopic group and in 10 patients in the microscopic group. There was no statistically significant difference between cerebrospinal fluid leakage and olfactory disturbances in both groups (P >0.05). Synechia was observed in nine patients in the microscopic group and in only one patient in the endoscopic group. There was a statistically significant difference between the presence of synechia and olfactory disturbances (P <0.05).

Conclusions: This is the first study to seek the difference between the endoscopic and microscopic transsphenoidal approaches on the olfactory system during pituitary surgery. The obtained results indicate that an endoscopic approach seems to be more advantageous than a microscopic approach for protecting olfactory system and function.
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http://dx.doi.org/10.1002/lary.24037DOI Listing
September 2013

Fahr's Syndrome Associated with Multiple Intracranial Aneurysms: A Case Report.

Turk Neurosurg 2016 ;26(4):643-645

Ankara University, School of Medicine, Department of Neurosurgery, Ankara, Turkey.

Fahr's Syndrome is characterized by the presence of intracerebral, bilateral and symmetrical calcifications located in bilateral basal ganglia, thalamus, and cerebellum. The etiology is not exactly known. The authors reported a very rare case who had Fahr's Syndrome and intracerebral aneurysms simultaneously. The patient was female and presented with headache. Her examinations revealed aneurysms on the middle cerebral artery, internal carotid artery and ophthalmic artery. That is the first case reported in the literature having multiple intracranial aneurysms and Fahr's Syndrome together.
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http://dx.doi.org/10.5137/1019-5149.JTN.8574-13.0DOI Listing
April 2017

High dose cotinine may induce neural tube defects in a chick embryo model.

Turk Neurosurg 2009 Jul;19(3):224-9

Ankara Numune Educational and Research Hospital, II. Neurosurgery Clinic, Ankara, Turkey.

Aim: Nicotine is a well-known agent among 4000 chemicals in cigarettes. About 70 to 80% of nicotine is converted to cotinine, a major metabolite. The aim of the present study is to investigate the effect of cotinine on neural tube development in a chick embryo model.

Material And Methods: Sixty fertile, specific pathogen free eggs were divided into 6 groups for this study. In the first group, a fixed cotinine concentration for each egg was calculated just to simulate the concentration of a smoker's blood level. A second experimental group was designed at a higher cotinine concentration. Embryos that succeeded to reach Hamburger-Hamilton stage 12 from each group were then embedded into paraffin for permanent sections. These two groups were compared with eggs subjected to vehicle (standard alcohol and ten times more alcohol concentration) and control groups (saline and sham groups).

Results: Embryos of the cotinine (regular dose), vehicle and control groups were normal, but embryos subjected to higher cotinine concentrations were malformed at the cranial part of the thoracic neural tube.

Conclusion: Association of cotinine with neural tube defects was demonstrated in the present study. Cigarette smoking may induce hazardous effects on neural tube development.
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July 2009

Gunshot injuries due to celebratory gun shootings.

Turk Neurosurg 2009 Jan;19(1):73-6

Ankara University, School of Medicine, Department of Neurosurgery, Ankara, Turkey.

Unlabelled: Traditional shooting with guns often occurs and leads to unwanted gunshot injuries in areas where celebrations are held. Such injuries have been classified as celebratory gun shooting injury in the international disease classification system.

Case: An 8-year-old female patient presented with respiratory arrest. The heartbeats normalized upon cardiopulmonary resuscitation. On physical examination, the only pathological finding was a skin defect measuring 1 x 1 cm on the midline and located 2 cm in front of the coronal suture. Cranial CT revealed a bone defect of 0.5 cm in the area 2 cm in front of the coronal suture on the midline, tetraventricular and extensive subarachnoid hemorrhage and parenchymal hematoma in the frontal area. It was initially thought to be a gunshot injury; however, on cranial CT, no bullet fragments or bullet exit hole was observed. A cervicothoracal direct graph was obtained and an image that might have been compatible with a bullet core was detected at Th 2-3 vertebra level.

Conclusion: Although gunshot injuries are generally well- known, this may not be a very familiar topic for neurosurgeons. The primary aim of this report is to emphasize that a bullet round randomly fired into the air ascends in reverse direction to gravity and after reaching a zero point, it returns to the ground at a high velocity that facilitates its penetration into the skull according to a principal physics law.
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January 2009

Arterial vascularization of primary motor cortex (precentral gyrus).

Surg Neurol 2005 ;64 Suppl 2:S48-52

Department of Neurosurgery, Faculty of Medicine, Ankara University, Sihhiye, Ankara 06100, Turkey.

Background: The precentral gyrus (PG) is the primary motor area and is one of the most eloquent brain regions of neurosurgical interest. Although the arterial supply to the PG is generally known, contributions from different arterial branches such as the anterior cerebral artery (ACA), posterior cerebral artery (PCA), and middle cerebral artery (MCA) have not been comprehensively studied. The aim of the present study was to provide detailed information about the arteries of the PG.

Methods: Twenty adult human brains (40 hemispheres) were obtained, and ACA, MCA, and PCA were separately cannulated and injected with latex. The PG was identified.

Results: The ACA supplied the medial one third and the MCA supplied the lateral two thirds of the PG. The PCA did not reach the PG in any of the hemispheres. In 16 hemispheres (40%), the callosomarginal artery and, in 13 hemispheres (32.5%), the pericallosal artery were dominant for the medial one third of the PG. In 11 hemispheres (27.5%), equal dominance was observed. MCA branches at the lateral tip of the PG were classified into precentral, central, and postcentral groups. In 29 hemispheres (72.5%), the central group, and in 4 hemispheres (10%), the precentral group were dominant for the lateral two thirds of the PG. In 7 hemispheres (17.5%), the precentral and central groups were equally dominant. No dominance was identified for the postcentral group.

Conclusion: In each hemisphere, the PG was supplied by different vascularization patterns of ACA and MCA. The present study is the first to describe and discuss these details. Therefore, awareness of this pattern will provide a great contribution to surgical interventions.
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http://dx.doi.org/10.1016/j.surneu.2005.07.049DOI Listing
December 2005

Brain abscess: magnetic resonance perfusion findings.

Curr Probl Diagn Radiol 2005 Jul-Aug;34(4):160-2

Department of Radiology, Ankara University School of Medicine, Turkey.

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http://dx.doi.org/10.1067/j.cpradiol.2005.04.004DOI Listing
October 2005

Tuberculous brain abscess in a patient with hyper IgE syndrome.

Pediatr Int 2004 Feb;46(1):97-100

Department of Pediatrics, School Security Ankara Education Hospital, Ankara, Turkey.

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http://dx.doi.org/10.1111/j.1328-0867.2004.01845.xDOI Listing
February 2004

Spinal cord regeneration induced by a voltage-gated calcium channel agonist.

Neurol Res 2002 Oct;24(7):639-42

Department of Neurological Surgery, University of Wisconsin Medical School, Clinical Science Center, Madison, USA.

Regeneration in the central nervous system (CNS) is prohibitive. This is likely due to an interplay of cellular (gene expression, growth factors) and environmental (inhibition by CNS myelin) factors. Calcium supports various intracellular functions, and multiple in vitro studies have shown a role of calcium in axonal growth. In this study, we examine the role of a calcium agonist, S(-)-Bay K 8644, in promoting or impeding CNS growth in vivo, in an effort to understand further the relationship between the voltage-gated L type calcium channel and regeneration. Using a well-established rat spinal cord model of regeneration, we have injected various doses of S(-)-Bay K 8644 (30-240 M) around the injured spinal cord. Our results demonstrate that S(-)-Bay K 8644 enhances regeneration in a dose-dependent fashion. In addition, at very specific concentrations, the same agonist has no effect on or even inhibits regeneration. We conclude that spinal regeneration is highly dependent on intracellular calcium concentration. Furthermore, depending on the dose used, the effect of calcium agonist supplementation on spinal regeneration can be supportive or inhibitory.
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http://dx.doi.org/10.1179/016164102101200672DOI Listing
October 2002

Resolution of cerebral vasospasm with trapidil; an animal model.

J Clin Neurosci 2002 Jul;9(4):429-32

Department of Neurosurgery, University of Mersin, Turkey.

Cerebral vasospasm and rebleeding are important clinical phenomena associated with a high mortality rate. Therefore, any promising finding in the laboratory deserves assessment in clinical practice. The present study was designed to examine the possible effects of trapidil on the basilar artery of the rabbit through a cerebral vasospasm model. This experimental study was carried out on 26 adult New Zealand albino rabbits of both sexes weighing 2.5-3.0 kg. A transclival exposure was performed. Vasospasm was produced by an intracisternal injection of autologous blood. After observation of the vasospasm, trapidil was locally applied in increasing concentrations (10(-5)-10(-4) M). The effect of each concentration was measured independently after 10 minutes for each application and was extended to three hours. Trapidil was shown to have a clear spasmolytic effect on the rabbit's basilar artery. These data suggest that trapidil can have a potential use in the treatment of patients suffering from cerebral vasospasm.
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http://dx.doi.org/10.1054/jocn.2001.1009DOI Listing
July 2002