Publications by authors named "Ahmet Murat Musluman"

30 Publications

  • Page 1 of 1

Early cranioplasty associated with a lower rate of post-traumatic hydrocephalus after decompressive craniectomy for traumatic brain injury.

Eur J Trauma Emerg Surg 2020 Aug 3;46(4):919-926. Epub 2020 Jun 3.

Department of Neurosurgery, Sisli Hamidiye Etfal Research and Education Hospital, University of Medical Sciences, Istanbul, Turkey.

Background: Post-traumatic hydrocephalus (PTH) is one of the primary complications during the course of traumatic brain injury (TBI). The aim of this study was to define factors associated with the development of PTH in patients who underwent unilateral decompressive craniectomy (DC) for TBI.

Methods: A total of 126 patients, who met the inclusion criteria of the study, were divided into two groups: patients with PTH (n = 25) and patients without PTH (n = 101). Their demographic, clinical, radiological, operative, and postoperative factors, which may be associated with the development of PTH, were compared.

Results: Multivariate logistic regression analysis revealed that cranioplasty performed later than 2 months following DC was significantly associated with the requirement for ventriculoperitoneal shunting due to PTH (p < 0.001). Also, a significant unfavorable outcome rate was observed in patients with PTH at 1-year follow-up according to the Glasgow Outcome Scale-Extended (p = 0.047).

Conclusions: Our results show that early cranioplasty within 2 months after DC was associated with a lower rate of PTH development after TBI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00068-020-01409-xDOI Listing
August 2020

Cranio-Orbital Tumors: Clinical Results and A Surgical Approach.

Sisli Etfal Hastan Tip Bul 2019 27;53(3):240-246. Epub 2019 Aug 27.

Department of Neurosurgery, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.

Objectives: In this study, we aimed to share the surgical approaches and clinical experiences of cranio-orbital tumors, which are surgically difficult anatomies.

Methods: A total of 22 orbital tumors with extraorbital-transcranial pathology between January 2004 and December 2017 were retrospectively reviewed. Information was obtained from hospital, operation and outpatient records for this study. Preoperative demographic data, ophthalmologic examination findings, clinical and radiological findings were recorded. All patients had cranial magnetic resonance and cranial computerised tomography examinations at this time. The location of the tumor, its size and its relation to neighboring structures were recorded in the light of these examinations.

Results: The lateral approach was performed in 12 cases. The lateral approach was performed with frontotemporal craniotomy. Because of the lateral inferior location of the tumor in three of 12 cases, zygoma osteotomy was added to classical osteotomy. In 10 cases, the anterior approach was applied and the frontal craniotomy was found sufficient in seven cases. In three cases subfrontal craniotomy was added to classical craniotomy.

Conclusion: The findings obtained in this study suggest that high resection rates can be achieved with appropriate surgical intervention in orbital tumors requiring a transcranial surgical approach. The most important factor in surgical planning is the location of the tumor. The size of the tumor and the expectation of the percentage of surgical removal are the other important factors. In our series, it has reached high excision ratio in most cases with low complication rate, good visual field and eye movements results.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.14744/SEMB.2018.82698DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7192274PMC
August 2019

Solitary Extramedullary Plasmacytoma Mimicking Acute Subdural Hematoma.

World Neurosurg 2018 Dec 27;120:521-524. Epub 2018 Sep 27.

Department of Neurosurgery, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.

Background: Solitary extramedullary plasmacytoma (SEP) is a plasma cell neoplasm located outside the bone. It is rarely observed in the intracranial area. It is very difficult to diagnose this condition radiologically before surgery. In addition, dural SEP is usually misdiagnosed.

Case Description: We report a case of plasmacytoma that presented as altered mental status after head trauma, located in the subdural area. We also describe its differential diagnosis and treatment by total removal and adjuvant radiotherapy. The 66-month follow-up findings showed distant plasmacytoma development, which was treated with radiotherapy alone.

Conclusions: Some pathological entities should be considered in the differential diagnosis of acute subdural hematomas. Furthermore, to the best of our knowledge, we report the first case of dural SEP mimicking acute subdural hematoma.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.wneu.2018.09.151DOI Listing
December 2018

Chronic subdural hematoma associated with arachnoid cyst of the middle fossa : Surgical treatment and mid-term results in fifteen patients.

Turk Neurosurg 2017 Oct 18. Epub 2017 Oct 18.

University of Health Sciences, Hamidiye Sisli Etfal SUAM, Department of Neurosurgery, Istanbul, Turkey.

Aim: We report the neurological and radiological features, surgical management and Mid-term outcome in a series of patients with chronic subdural hematoma (CSDH) and associated ipsilateral arachnoid cyst (AC) of the middle fossa.

Material And Methods: Between August 2004 and August 2012, 453 patients were treated with diagnosis of CSDH in our clinic. Of those, 15 patients had ipsilateral arachnoid cyst in the middle fossa. A single burr hole craniostomy was performed to drain the hematoma and the AC left intact at first in 14 patients, one patient had no surgical intervention. Follow-up period ranged from 13 months to 88 months (mean 43.07 ± 23.23 months).

Results: The patients having CSDH with AC were found to be younger than the patients with CSDH alone, the mean age was 13.93 ±12.37 years Eleven patients had head trauma 21 to 50 days before admission. Hematoma evacuation through a single burr hole and closed system subdural drainage 2 to 4 days after surgery improved the symptoms in all patients. Two patients developed subdural fluid collection which is treated by subduroperitoneal shunt placement.

Conclusion: Greater prevalence of ACs in patients with CSDHs has been reported in the literature. We recommend the drainage of the hematoma via a single craniostomy and to leave the AC intact as the first choice of treatment if the associated AC is a Galassi type I or II. Additional subduroperitoneal shunting may be performed in patients with Galassi type III cyst.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5137/1019-5149.JTN.21513-17.3DOI Listing
October 2017

Inverse Association Between Basilar Artery Volume and Neuron Density in the Stellate Ganglion Following Bilateral Common Carotid Artery Ligation: An Experimental Study.

World Neurosurg 2017 Apr 19;100:138-143. Epub 2016 Dec 19.

Department of Pathology, Medical Faculty of Atatürk University, Erzurum, Turkey.

Objective: This study examined the relationship between neuron density in the stellate ganglion and the severity of basilar artery (BA) enlargement after bilateral common carotid artery ligation.

Methods: Rabbits (n = 24) were randomly divided into 3 groups: unoperated control group (n = 4), experimental group subjected to bilateral common carotid artery ligation (n = 15), and sham-operated control group (n = 5). Histologic examination of the BAs and stellate ganglia was performed 2 months later. Permanent bilateral common carotid artery ligation was induced by ligation of common carotid arteries at prebifurcation levels as a model for steno-occlusive carotid artery disease.

Results: Mean BA volume and neuron density in stellate ganglia for all animals were 4200 μm ± 240 and 8325 μm ± 210. In sham-operated animals, the mean values were 4360 μm ± 340 and 8250 mm ± 250. For the experimental group, mean volume and density in animals with slight dilatation of the BA (n = 6) were 4948 μm ± 680 and 10,321 mm ± 120, whereas in animals with severe dilatation (n = 9), the values were 6728 μm ± 440 and 6300 mm ± 730. An inverse association was observed between degree of BA enlargement and stellate ganglia neuronal density.

Conclusions: High neuron density in stellate ganglia may protect against steno-occlusive carotid artery disease by preventing BA dilatation and aneurysm formation in the posterior circulatory arteries.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.wneu.2016.12.034DOI Listing
April 2017

Factors that Affect Postoperative Hydrocephalus Development in Aneurysmal Subarachnoid Hemorrhage: A Clinical Study.

Turk Neurosurg 2017 ;27(3):353-361

Sisli Hamidiye Etfal Research and Education Hospital, Department of Neurosurgery, Istanbul, Turkey.

Aim: Factors affecting the development of postoperative hydrocephalus patients who underwent surgery after aneurysmal subarachnoid hemorrhage were retrospectively assessed.

Material And Methods: 201 cases, who underwent aneurysm surgery in our clinic after subarachnoid hemorrhage between 2008 and 2013, were retrospectively assessed. Twenty-one cases with hydrocephalus development were retrospectively examined according to their age, gender, history (hypertension, alcohol, and smoking), blood type, the number and size of aneurysms, aneurysm localization, the presence of ventricular hemorrhage, baseline-final neurological diagnosis, Fisher grading system, history of vasospasm and meningitis. The initial neurological course and Hunt-Hess, and also final neurological course of the patients were evaluated according to World Federation of Neurosurgical Societies (WFNS) Grading Scale.

Results: Age, history of hypertension, aneurysm localization, Hunt-Hess grading, vasospasm, meningitis and Glasgow Outcome Scale (GOS) are determinative factors in hydrocephalus development due to subarachnoid hemorrhage. It was detected that gender, alcohol and tobacco use, blood group, the size and the number of aneurysm, the presence of intraventricular hemorrhage and Fisher grading were not the determinative factors in the patients.

Conclusion: In patients who underwent surgery for subarachnoid hemorrhage, risk factors for postoperative hydrocephalus should be determined and the patients with these risk factors should be closely monitored.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5137/1019-5149.JTN.16400-15.1DOI Listing
December 2017

Computerized Tomography-Guided Stereotactic Biopsy of Intracranial Lesions: Report of 500 Consecutive Cases.

Turk Neurosurg 2017 ;27(3):395-400

Sisli Hamidiye Etfal Research and Training Hospital, Clinic of Neurosurgery, Istanbul, Turkey.

Aim: Computed tomography (CT)-guided stereotactic brain biopsy has been performed in our clinic since March 1998. In this prospective study, we examined the patient data undergoing stereotactic biopsy and the results of biopsies in 500 consecutive patients.

Material And Methods: Between the dates of March 1998 and January 2015, CT-guided stereotactic biopsies were performed by using the Leksell stereotactic frame system (Elekta Instruments EU, Sweden) in 500 patients. A total of 512 procedures were performed in patients consisting of 184 females (36.8%) and 316 males (63.2%), ages ranging from 3 to 81 years (mean 50.40±16.67).

Results: Conclusive histopathological diagnosis was not achieved in 17(3.3%) of 512 procedures. Of the others, 173 (33.8%) were high-grade gliomas, 103 (20.1%) were low-grade gliomas, 36 (7%) were malignant lymphomas, 34 (6.6%) were other types of brain tumors, 82 (16%) were metastasis and 67 (13.1%) were non-tumoral lesions. Complications were occurred in ten cases: 3 tumoral bleedings, 2 hypertensive cerebral hematomas, 2 peroperative convulsions, 1 epidural hematoma, 1 myocardial infarction and 1 brain edema. The patients who developed myocardial infarction and hypertensive thalamic hematoma died. The mortality was 0.4% and morbidity was 1.6% in 512 procedures.

Conclusion: CT-guided stereotactic biopsy is a reliable and a safe procedure in cases with intracranial lesions when histopathological diagnosis is required for the appropriate treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5137/1019-5149.JTN.16280-15.1DOI Listing
December 2017

Spinal nerve root compositions of musculocutaneous nerve: an anatomical study.

Turk Neurosurg 2014 ;24(6):880-4

Baskent University, School of Medicine, Department of Orthopedic Surgery, Istanbul, Turkey.

Aim: This study was aimed to investigate the variations in the spinal nerve root compositions of musculocutaneous nerve and to confirm which spinal nerve root is the main ingredient in participating amount.

Material And Methods: A total of 20 fresh cadavers were dissected. Brachial plexus and its branches were extracted. Musculocutaneous nerve stump was traced back to the roots to identify its fascicular origin. The number of fascicles originating from a particular nerve root and their axial location with in the nerve were noted.

Results: The most frequent type of spinal nerve compositions of musculocutaneous nerve was C5, C6, and C7 with incidence of 60%. Musculocutaneous nerve had bundles from C5 root in all specimens, 90% of the specimens had contribution from C6 and only 70% of them had bundles from C7 root. There were a total of 46 (37.7%) bundles in C5 fascicles, 48 (39.3%) bundles in C6 fascicles, and 28 (22.9%) bundles in C7 fascicles.

Conclusions: In electrophysiological studies it should be remembered that C7 or C6 lesions may not impair musculocutaneous nerve functions. The success of musculocutaneous nerve neurotization may be improved if care is taken to ensure whether or not C7 root is contributing to the musculocutaneous nerve.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5137/1019-5149.JTN.9145-13.1DOI Listing
December 2015

Immunohistochemical expression of ErbB2 in adamantinomatous craniopharyngiomas: a possible target for immunotherapy.

Turk Neurosurg 2013 ;23(1):55-60

Sisli Etfal Training and Research Hospital, Department of Endocrinology and Metabolism, Istanbul, Turkey.

Aim: To determine the immunohistochemical expression of ErbB2 in adamantinomatous craniopharyngiomas (ACP) and to assess its relationship with nuclear expression of β-catenin in surgically resected human ACP tissue sections and to estimate whether these tumors could be candidates for anti-ErbB2 therapy.

Material And Methods: The ErbB2 and β-catenin immunostaining was performed on paraffin embedded tissue sections of 20 ACP using avidin-biotin-peroxidase complex method. ErbB2 immunoreactivity was interpreted according to the American Society of Clinical Oncology/ College of American Pathologists criterions for breast carcinoma.

Results: Foci of nuclear reactivity for β-catenin was observed in all ACP tissue specimens mainly concentrated in whorl like arrays of the epithelial cells. Two (10%) of the cases were score 3+ for ErbB2 as demonstrated by strong complete membrane staining. However, the localization of 3+ ErbB2 cells was different from those with nuclear β-catenin immunoreactivity.

Conclusion: Our preliminary data demonstrate score 3+ staining for ErbB2 in 10% of ACP and different localization of 3+ ErbB2 cells and cells with nuclear β-catenin immunoreactivity. However, because of the small number of cases, further studies with larger samples should be conducted to verify and validate our preliminary data and to determine the effect of ErbB2 protein in ACP cell growth, survival and differentiation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5137/1019-5149.JTN.6706-12.1DOI Listing
July 2013

Giant osteoid osteoma of the ethmoid bone with unusual large nidus.

J Neurosci Rural Pract 2012 Sep;3(3):383-5

Department of Neurosurgery, Clinic of Neurosurgery, ŞişliEtfal Education and Research Hospital, Istanbul, Turkey.

Osteoid osteoma (OO) is a benign bone neoplasm which is seen in the long bones of appendicular skeleton. It is rarely seen in the cranium. Ethmoid bone OO has been very rarely reported so far. We report another case of giant osteoid osteoma involving the ethmoid bone with intraorbital and intracranial extension in a 3O year old female patient. This case with unusual anatomical location was presented. It is first time reporting a giant osteoid osteoma of ethmoid bone with such a large nidus.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/0976-3147.102637DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505348PMC
September 2012

Clip ligation of unruptured intracranial aneurysms: a prospective midterm outcome study.

Acta Neurochir (Wien) 2012 Jul 29;154(7):1135-44. Epub 2012 May 29.

Clinic of Neurosurgery, Şişli Etfal Education and Research Hospital, Istanbul, 34077, Turkey.

Background: We conducted a prospective study to investigate the clinical and radiological outcome in a surgical case series of 176 patients with 203 unruptured intracranial aneurysms (UIA).

Methods: The success of aneurysm obliteration was assessed within 2 weeks after surgery by digital subtraction angiography (DSA). Patients also underwent angiography 5 years after surgery. Clinical outcomes were assessed using the modified Rankin Scale (mRS). All predictors of poor surgical outcomes were assessed using an exact logistic regression.

Results: Overall, 83 % of the patients had a good outcome (mRS score 0 or 1); 10.8 % of the patients had a slight disability (mRS score 2), and 6.2 % of the patients had a moderate or moderate-severe disability (mRS score 3 or 4). The mortality rate was 0 % overall. The most important predictors of outcome were presence of history of ischemic cerebrovascular disease and postoperative stroke. Complete aneurysm occlusion was achieved in 93.5 % of all aneurysms. Sixty percent of treated aneurysms were checked with late follow-up DSA. No cases of hemorrhage from a surgically obliterated UIA were documented in this series during the 7.3 ± 1.4 (SD)-year follow-up period.

Conclusions: If patients are carefully selected and individually assigned to their optimum treatment modality, IUAs can be obliterated by surgery with a low percentage of unfavorable outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00701-012-1397-yDOI Listing
July 2012

Clinical outcomes of myelomeningocele defect closure over 10 years.

J Clin Neurosci 2012 Jul 16;19(7):984-90. Epub 2012 May 16.

Clinic of Neurosurgery, Şişli Etfal Education and Research Hospital (Şişli Etfal Eğitim ve Araştırma Hast.), Beyin ve Sinir Cerr, Kliniği, Şişli, Istanbul 34381, Turkey.

We report our surgical procedures for the closure of myelomeningocele defects. A retrospective analysis of 162 patients (74 male [45.7%], 88 female [54.3%]) with myelomeningocele was performed and the relationship between hydrocephalus, neurological status and the level and size of the myelomeningocele was described according to type of defect closure. Patients were divided into four groups according to the size of the defect, which was classified into ranges of 0-24 cm(2), 25-39 cm(2), 40-60 cm(2) and >60 cm(2). Myelomeningocele occurred in the lumbar region in 114 patients (70%). The minimum defect size was 3×2 cm, and the maximum defect size was 15×15 cm (mean defect size=34.64 cm(2)). We found that primary closure can be performed on clean, small defects with an intact sac that contains cerebrospinal fluid and the neural placode. For defects larger than 25 cm(2) that contained perforated sacculas, more soft tissue for well-vascularized coverage was required. Bilateral V-Y fasciocutaneous flaps are a good choice for immediate coverage of myelomeningocele defects.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jocn.2011.09.026DOI Listing
July 2012

Risk factors for recurrent shunt infections in children.

J Clin Neurosci 2012 Jun 18;19(6):844-8. Epub 2012 Apr 18.

Department of Neurosurgery, Sisli Etfal Training and Research Hospital, Halaskargazi Street, Istanbul 34100, Turkey.

Risk factors for recurrent shunt-related cerebrospinal fluid (CSF) infections were analyzed. A total of 58 children were treated for initial shunt infections (ISI): all children were treated with antibiotics and CSF drainage, either by removal of the shunt system and insertion of an external ventricular drainage (EVD) catheter (44 children, 75.9%) or by externalization of the existing ventricular catheter (14 children, 24.1%). Recurrent shunt infections (RSI) were detected in 15 children: nine had been treated with shunt removal and insertion of a new EVD catheter and six had been treated with externalization of the existing ventricular catheter. There was a statistically significant increase in the number of RSI in children treated with externalization of the existing ventricular catheter. Thus, to reduce the risk of RSI, total shunt removal and insertion of a new EVD catheter is preferred.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jocn.2011.07.054DOI Listing
June 2012

Unilateral frontal interhemispheric transfalcial approaches for the removal of olfactory groove meninjiomas.

Turk Neurosurg 2012 ;22(2):174-82

Sisli Etfal Research and Education Hospital, Department of Neurosurgery, Istanbul, Turkey.

Aim: A unilateral subfrontal interhemispheric transfalcial approach for the removal of olfactory groove meningiomas (OGM) was evaluated in terms of surgical technique, complications, clinical outcomes, and recurrence rate.

Material And Methods: Twenty-four females and eighteen males with a mean age of 59 years were operated on for OGM within a 12- year (1996-2008) period. The pre- and post-operative Mini-Mental Test (MMT) scores, visual impairment scores (VIS), pre-operative clinical symptoms (headache, epileptic seizure and anosmia), Karnofsky performance scores (KPS), tumor size and tumor extensions were evaluated. The effects of the pre-operative parameters on post-operative MMT, VIS and KPS were investigated.

Results: Tumor size and pre-operative MMT significantly affected pre-operative KPS. Mean tumor diameter was 5.6±0.8 cm. Total excision was achieved in 97.6% of all cases. No peri-operative mortality was seen. Ten patients (23.8%) experienced surgery-related complications. The mean follow-up period of cases was 52 months, and the rate of residual tumor re-growth was 2.3%. No parameter showed any effect on post-operative KPS, as no significant difference was seen between pre- and post-operative KPS. A significant positive difference was detected between pre- and post-operative MMT and VIS.

Conclusion: A unilateral subfrontal interhemispheric transfalcial approach can be the preferred modality for treating OGM.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5137/1019-5149.JTN.4749-11.1DOI Listing
July 2012

Recurrent cerebral arteriovenous malformation with a posterior inferior cerebellar artery aneurysm.

Turk Neurosurg 2011 ;21(4):674-9

Şişli Etfal Education and Research Hospital, Clinic of Neurosurgery, Istanbul, Turkey.

Aim: Cerebral arteriovenous malformations (AVMs) are congenital lesions which rarely recur after complete microsurgical excision.

Material And Methods: This case report presents a 35-year-old woman who had been referred with a hemorrhagic AVM five years ago. This patient has recently undergone microsurgical excision for her left parieto-occipital Grade II AVM and surgical clipping of the left posterior inferior cerebellar artery (PICA) aneurysm which was concomitantly detected. She is the oldest case reported whose AVM recurred as Grade III, which is bigger than her first AVM associated with an aneurysm.

Conclusion: Although some authors do not propose routine additional follow-up in adults after the initial negative postoperative angiogram, we believe that such patients should be followed clinically and radiologically.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5137/1019-5149.JTN .3059-10.2DOI Listing
April 2012

The effect of degenerated neuron density of petrosal ganglion on the development of blood pressure variabilities after subarachnoid hemorrhage in a rabbit model: an experimental study.

Turk Neurosurg 2011 ;21(4):559-66

Sisli Research and Education Hospital, Department of Neurosurgery, Istanbul Turkey.

Aim: The aim of this study was to determine the relationship between ischemic neurodegeneration, of the petrosal ganglion of the glossopharyngeal nerve, and BP fluctuations, after subarachnoid hemorrhage (SAH).

Material And Methods: Twenty-four rabbits had their blood pressure and heart rhythms studied daily over 20 days. Then, the histopathology of the petrosal ganglion was examined in all animals. Normal and apoptotic neuron density of the petrosal ganglion and blood pressure values were compared statistically.

Results: Mean total volume of the petrosal ganglia was calculated as 0.9 ± 0.34/mm3. BP level of control group was 96.1 ± 2.1 mmHg; 116.5 ± 4 mmHg of mild hypertension (HT) group and 128.1 ± 3.6mmHg in the severe HT group. When the groups were compared to each other they were significantly different. The level of normal-apoptotic neuron in control group was 11,240 ± 802/mm³ -40 ± 6.3/mm³; 9730 ± 148.7/mm³ - 1560 ± 256.2/mm³ in the mild HT group and 6870 ± 378.8/mm³-4240 ± 628.2/mm³ in the severe HT group. When the groups were compared to each other there was significantly difference.

Conclusion: Blood pressure variability observed in this study may be explained by ischemic neurodegeneration of petrosal ganglia caused by SAH. The results of this study suggest that petrosal ganglion ischemia has potential implications for the development of hypertension. These findings suggest that new treatment strategies should be considered for the treatment of SAH.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5137/1019-5149.JTN .4553-11.1DOI Listing
April 2012

The effect of choroidal artery vasospasm on choroid plexus injury in subarachnoid hemorrhage: experimental study.

Turk Neurosurg 2011 ;21(4):477-82

Sisli Etfal Education and Research Hospital, Department of Neurosurgery, Istanbul, Turkey.

Aim: We examined whether vasospasm of choroidal arteries (ChAs) may be resulted in ischemic injury in choroid plexus (CP) after subarachnoid hemorrhage (SAH).

Material And Methods: This study has been conducted on 30 rabbits. Eight, fourteen and eight of them were used as control, SAH and SHAM groups, respectively. The volumes of choroidal arteries were examined and measured by using the micrometric microscope barr. Ischemic morphological changes of the choroid plexus cells and villus were examined as follows: cellular shrinkage (1 point), cytoplasmic condensation (2 points), angulation (3 points) and villus desquamation (4 points) were considered as 1st, 2nd, 3rd, 4th degree downward choroid plexus degeneration criteria. Degeneration scores of 1 to 4 criteria were calculated by summing the exacerbated ones with the existing one.

Results: Choroidal artery diameter&volume, and CP degeneration scores in three groups were evaluated: The mean volumes were 1.080 ± 0.650 mm³, 0.907 ± 0.330 mm³, 0.480 ± 0.175 mm³ and the degeneration scores of choroidal plexuses were scored as 0 and 1- 1, and 4- 3 and 10 in the control, SHAM and SAH groups respectively. A significant correlation between the degree of vasospasm and CP degeneration was found.

Conclusion: Vasospasm of choroidal arteries may be at a serious degree in cases with SAH incurs damages on choroid plexuses, and affects structures which play important roles in immune, endocrine, detoxifying, thermoregulatory, and secretory functions of the brain resulting in worsened prognosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5137/1019-5149.JTN .4204-11.1DOI Listing
April 2012

Midterm outcome after a microsurgical unilateral approach for bilateral decompression of lumbar degenerative spondylolisthesis.

J Neurosurg Spine 2012 Jan 26;16(1):68-76. Epub 2011 Aug 26.

Clinic of Neurosurgery, Şişli Etfal Education and Research Hospital, Istanbul, Turkey.

Object: The aim of this study was to evaluate the results and effectiveness of bilateral decompression via a unilateral approach in the treatment of lumbar degenerative spondylolisthesis (DS).

Methods: Operations were performed in 84 selected patients (mean age 62.1 ± 10 years) with lumbar DS between the years 2001 and 2008. The selection criteria included lower back pain with or without sciatica, neurogenic claudication that had not improved after at least 6 months of conservative treatment, and a radiological diagnosis of Grade I DS and lumbar stenosis. Decompression was performed at 3 levels in 15.5%, 2 levels in 54.8%, and 1 level in 29.7% of the patients with 1 level of spondylolisthesis. All patients were followed up for at least 24 months. For clinical evaluations, a visual analog scale, Oswestry Disability Index (ODI), and Neurogenic Claudication Outcome Score (NCOS) were used. Spinal canal size and (neutral and dynamic) slip percentages were measured both pre- and postoperatively.

Results: Neutral and dynamic slip percentages did not significantly change after surgery (p = 0.67 and p = 0.63, respectively). Spinal canal size increased from 50.6 ± 5.9 to 102.8 ± 9.5 mm(2) (p < 0.001). The ODI decreased significantly in both the early and late follow-up evaluations, and good or excellent results were obtained in 64 cases (80%). The NCOS demonstrated significant improvement in the late follow-up results (p < 0.001). One patient (1.2%) required secondary fusion during the follow-up period.

Conclusions: Postoperative clinical improvement and radiological findings clearly demonstrated that the unilateral approach for treating 1-level and multilevel lumbar spinal stenosis with DS is a safe, effective, and minimally invasive method in terms of reducing the need for stabilization.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3171/2011.7.SPINE11222DOI Listing
January 2012

Role of neuron density of the stellate ganglion on regulation of the basilar artery volume in subarachnoid hemorrhage: An experimental study.

Auton Neurosci 2011 Dec 25;165(2):163-7. Epub 2011 Aug 25.

Department of Neurosurgery, Medical Faculty of Rize University, Rize, Turkey.

Background: The role of neuron density (of the stellate ganglion) in basilar artery vasospasm after subarachnoid hemorrhage (SAH) has not previously been investigated. This subject was studied.

Methods: This study was conducted on 24 rabbits. Four of them were used as the baseline control group. Experimental SAH was applied to the 15 animals; the remaining five of them were used as a sham group injecting by the serum physiologic saline (PS) and followed up twenty days later. Stellate ganglion neuron densities were estimated stereologically. Vasospasm index (VSI) was used to assess the severity of vasospasm. The value of VSI between 1 and 1.5 was accepted as no vasospasm, 1.5-2 was accepted as light vasospasm and 2 or greater than 2 was accepted as severe vasospasm. Results were compared statistically.

Results: The mean basilar artery VSI in the control group (n: 4) was calculated as 1.24±0.39 and the neuron density of stellate ganglion was calculated as 8320±675/mm(3). These values in the PS group (n: 5) were calculated as 1.26±0.37 and 8380±680/mm(3). In animals with light basilar artery vasospasm (n: 6), the basilar artery VSI and neuron density of stellate ganglion were 1.65±0.37, 9210±460/mm(3) consecutively, but the basilar artery VSI was 2.07±0.40 and neuron density was 12,075±950/mm(3) in animals with severe vasospasm (n: 9).

Conclusion: The neuron density of stellate ganglion may play an important role in the development of basilar artery vasospasm. The beneficial effect of sympathectomy for the prevention of cerebral vasospasm may be explained through this mechanism.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.autneu.2011.06.008DOI Listing
December 2011

Surgical results of large and giant pituitary adenomas with special consideration of ophthalmologic outcomes.

World Neurosurg 2011 Jul-Aug;76(1-2):141-8; discussion 63-6

Department of Neurosurgery, Sisli Research and Education Hospital, Baskent University Medical School, Istanbul, Turkey.

Objective: To analyze functioning and nonfunctioning pituitary adenomas (PAs)>3 cm, with special emphasis on preoperative and postoperative visual functions.

Methods: The cases consisted of 49 women and 54 men with mean age of 43.2 years (range 19-66 years). All cases had a macroadenoma >3 cm in diameter. The transsphenoidal approach was performed in 117 procedures, and the transcranial approach was performed in 8 procedures. Radical tumor excision was achieved in 50 of 103 patients. Postoperative evaluation was done in 88 patients. Preoperative and postoperative visual acuity, visual field, and ocular fundi and their relationship with the pattern and duration of the symptoms and the size of the tumor were evaluated.

Results: Normalization of visual acuity was obtained in 71.5% of patients, improvement occurred in 13.6%, symptoms persisted in 13.6%, and symptoms worsened in 1%. Postoperative improvement of visual field defects (VFDs) was observed in 74.1% of patients, and visual impairment score improved postoperatively in 92% of patients. Patients operated on <6 months before the onset of vision loss had better and more sustained visual improvement. One patient died, and 15.5% of patients experienced surgery-related complications.

Conclusions: This study shows that patients with severe visual impairment may have remarkable improvement if surgical decompression is done early. The transsphenoidal approach should be performed to correct the patient's visual impairment and to relieve the pressure on the optic apparatus caused by macroadenoma of any size.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.wneu.2011.02.009DOI Listing
October 2011

MGMT immunoexpression in growth hormone-secreting pituitary adenomas and its correlation with Ki-67 labeling index and cytokeratin distribution pattern.

Endocrine 2011 Oct 15;40(2):222-7. Epub 2011 May 15.

Endocrinology and Metabolism Clinic, Sisli Etfal Training and Research Hospital, 34377 Sisli, Istanbul, Turkey.

Recent publications suggest the utility of temozolomide (TMZ) in the management of aggressive pituitary adenomas and carcinomas, resistant to conventional treatments. The response to TMZ is inversely correlated with tumoral expression of O-6 methylguanine DNA methyl transferase (MGMT). Therefore, we aimed to assess MGMT immunoexpression in pure GH-secreting pituitary adenomas, in an effort to predict the likelihood of response to TMZ, and to correlate MGMT immunoexpression with Ki-67 LI and cytokeratin (CK) distribution pattern. Our material consisted of 36 GH-secreting pituitary adenomas (21 female,15 male, mean age 42.5±10.5), operated at our center between 2003 and 2010. Immunostaining for MGMT, Ki-67, and CK was performed using avidin-biotin-peroxidase complex method. Immunoreactivity for MGMT and Ki-67 was evaluated microscopically and recorded as percentages of positive nuclear immunostaining. CK distribution pattern was also evaluated microscopically and assoreted into dot-like and nondot-like pattern subtypes. MGMT immunoexpression scored as 0=none, 1=<10%, 2=<25%, 3=<50%, and 4=>50%. Staining for MGMT was <10% (score 1) in 30 (83.3%), 10-25% (score 2) in 3 (8.3%), 25-50% (score 3) in 2 (5.6%) and >50% (score 4) in 1 (2.8%) of the tumors, respectively. There was no correlation between Ki-67 LI and CK distribution pattern with MGMT immunoreactivity (P>0.05). Data from the current study suggest a large proportion of GH-secreting adenomas, including those with dot-like CK distribution pattern and high Ki-67 LI, demonstrate negative/low MGMT immunoreactivity and could be treated with TMZ, if conventional treatment fails.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12020-011-9485-yDOI Listing
October 2011

The correlation between hematoma volume and outcome in ruptured posterior fossa arteriovenous malformations indicates the importance of surgical evacuation of hematomas.

Turk Neurosurg 2011 ;21(2):152-9

M.H. Sisli Etfal Research and Education Hospital, Department of Neurosurgery, Istanbul, Turkey.

Aim: The correlation between hematoma volume and outcome in ruptured arteriovenous malformations (AVM) with accompanying posterior fossa hematoma was retrospectively evaluated.

Material And Methods: Microsurgery operations were performed on 127 patients with intracranial AVM between January 1998 and January 2009 at our clinic. Fifteen (11.8%) patients were identified as suffering from posterior fossa AVM, and twelve of these patients presented with a cerebellar hematoma. All patients were clinically evaluated according to the following criteria: modified Rankin Scale (mRS) prior to surgery, Spetzler-Martin grade (SMG) of the AVMs, hematoma volume prior to surgery, and mRS following surgery.

Results: Postoperative mRS scores were significantly lower than preoperative scores (p=0.0001). Postoperative outcomes were concordant with the SMG of the AVMs (r=0.67, p=0.033), hematoma volume (r=0.537, p=0.072) and preoperative mRS scores (r=0.764, p=0.004). These analyses show that the postoperative mRS score is strongly correlated with a preoperative mRS score, hematoma volume and SMG.

Conclusion: Posterior fossa AVMs present an increased risk for hemorrhage and for increased morbidity and mortality. Cases with hematoma should be operated on an urgent basis. We conclude that hematoma volume is a factor that impacts postoperative results and prognosis. SMG and preoperative mRS scores were also correlated with outcome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5137/1019-5149.JTN.3401-10.0DOI Listing
September 2011

When is duraplasty required in the surgical treatment of Chiari malformation type I based on tonsillar descending grading scale?

World Neurosurg 2011 Feb;75(2):307-13

Department of Neurosurgery, Sisli Research and Education Hospital, Istanbul, Turkey.

Objective: To evaluate the effect of duraplasty based on cerebellar tonsillar descent (CTD) grade in the surgical treatment of Chiari malformation type I (CM-I).

Methods: Medical records and magnetic resonance imaging (MRI) scans of 82 patients with surgical correction of CM-I performed at the authors' clinic from 1998-2009 were reviewed. The preoperative CTD grading scale was obtained. Patients were divided two groups: duraplasty group (group 1) and nonduraplasty group (group 2). The preoperative and postoperative size of the syringomyelia cavity, Japanese Orthopaedic Association (JOA) scores, recovery rate, and postoperative complications were determined.

Results: There was 58 patients in group 1, who underwent combined foramen magnum decompression, C1 (and C2 if necessary) laminectomy, and duraplasty; the 24 patients in group 2 underwent posterior fossa decompression (PFD) alone with no dural opening performed. There were no statistically significant differences between preoperative and postoperative size of the syringomyelia cavity and JOA scores of duraplasty (group 1) and nonduraplasty (group 2) groups in CTD grades 1 and 2; in CTD grade 3, the decrease in syrinx cavity and clinical improvement were statistically better in group 1 compared with group 2 (P < 0.05). Complications in group 1 were statistically significantly increased compared with group 2 (P < 0.05).

Conclusions: This study shows that PFD and duraplasty for the treatment of CTD grade 3 Chiari malformation may lead to a more reliable reduction in the volume of concomitant syringomyelia and JOA scores. In CTD grade 1 and 2 patients, PFD without duraplasty may be performed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.wneu.2010.09.005DOI Listing
February 2011

MGMT immunoexpression in adamantinomatous craniopharyngiomas.

Pituitary 2011 Dec;14(4):323-7

Endocrinology and Metabolism Clinic, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.

At present, no effective medical treatment exists for recurrent and aggressive craniopharyngiomas that are resistant to conventional therapies, including surgery and adjuvant radiotherapy. Temozolomide is an alkylating chemotherapeutic agent used routinely in the management of high grade gliomas. The response to temozolomide is suggested to be dependent on the tumoral expression of O-6 methylguanine DNA methyltransferase (MGMT). Evidence supports that low MGMT immunoexpression correlates with positive response to temozolomide. Therefore, we aimed to assess MGMT immunoexpression in adamantinomatous craniopharyngiomas, in an effort to predict the likelihood of response to temozolomide. The MGMT immunostaining was performed on 23 adamantinomatous craniofaryngiomas operated at the Sisli Etfal Training and Research Hospital and identified by histological analysis. Paraffin embedded tissue sections were immunostained for MGMT and were evaluated semi-quantitatively. Of the 23 cases evaluated, 22 (96%) demonstrated negative (<10%) and 1 (4%) demonstrated low (10%) MGMT immunoexpression. Data from this study suggest a high proportion of adamantinomatous craniopharyngiomas exhibit negative/low MGMT immunoreactivity and could be treated with temozolomide, if conventional therapy fails.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11102-011-0297-0DOI Listing
December 2011

Posterior lumbar interbody fusion versus posterolateral fusion with instrumentation in the treatment of low-grade isthmic spondylolisthesis: midterm clinical outcomes.

J Neurosurg Spine 2011 Apr 11;14(4):488-96. Epub 2011 Feb 11.

Clinic of Neurosurgery, Şişli Etfal Education and Research Hospital, İstanbul, Turkey.

Object: The purpose of this study was to compare the methods of posterior lumbar interbody fusion (PLIF) and posterolateral fusion (PLF) in cases of isthmic Grades 1 and 2 lumbar spondylolisthesis, and to evaluate the clinical efficacy of the procedures.

Methods: Operations were performed in 50 patients with lumbar spondylolisthesis in the authors' clinics between 2001 and 2007. Indications for surgery were low-back pain with or without sciatica and neurogenic claudication that had not improved after at least 6 months of conservative treatment. The study included 33 female and 17 male patients, with mean ages of 50.6 years in the PLIF group and 47.3 years in the PLF group. These patients were randomly allocated into 2 groups: decompression, posterior transpedicular instrumentation, and PLF (Group 1; 25 patients) and decompression, posterior transpedicular instrumentation, and PLIF (Group 2; 25 patients). In the PLIF group, titanium cages were used, and autograft material was obtained from the decompression. In the PLF group, bone fragments collected from the iliac crest were used as autografts. A minimum 18-month follow-up was available in all patients. For clinical evaluation, a visual analog scale, Oswestry Disability Index, and the 36-Item Short Form Health Survey were used. Improvements in pre- and postoperative spondylolisthesis, segmental angles, fusion ratios, and postoperative complications were evaluated radiologically.

Results: The average follow-up period was 3.3 years. Based on the etiologies, isthmic spondylolisthesis was detected in all patients. The spondylolisthesis levels in the patients who underwent PLIF were located at L3-4 (5 patients, 20%); L4-5 (14, 56%); and L5-S1 (6, 24%), whereas the levels in the ones treated with PLF were located at L3-4 (4 patients, 16%); L4-5 (13, 52%); and L5-S1 (8, 32%). In the clinical evaluations, good or excellent results were obtained in 22 (88%) cases in the PLIF group and 19 (76%) cases in the PLF group. Fusion ratios were 100% in the PLIF group and 84% in the PLF group. Both lumbar lordosis and the segmental angle showed greater improvement in the PLIF group. There was no difference in the complication rates for each group.

Conclusions: Based on early clinical outcomes and the fusion ratios of adult isthmic spondylolisthesis, the authors found PLIF to be superior to PLF.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3171/2010.11.SPINE10281DOI Listing
April 2011

Transfacial approach, pedicled rhinotomy for a clival chordoma: a technical report.

Turk Neurosurg 2011 Jan;21(1):86-9

Sisli Etfal Education and Research Hospital, Department of Neurosurgery, Istanbul, Turkey.

Clival chordomas are frequently midline structures. Due to their critical location, invasive nature and aggressive recurrences, skull base chordomas are difficult to manage surgically. We present a case operated on with the pedicled transnasal and transfacial approach. The case presented with neurological deficits as cranial nerve palsy and findings of brainstem compression. The lesion was removed without any neurological deficit. Her deficits related to brainstem compression regressed after surgery. In our case, a large exposure was achieved through a lateral nasal incision in order to excise the tumor totally with acceptable cosmetic results, and a successful outcome was observed during the postoperative follow-up period with the surgical procedure applied.
View Article and Find Full Text PDF

Download full-text PDF

Source
January 2011

Shunt insertion in newborns with myeloschisis/myelomenigocele and hydrocephalus.

J Clin Neurosci 2010 Dec;17(12):1493-6

Neurosurgery Clinic, Şişli Etfal Education and Research Hospital, Şişli, İstanbul 34077, Turkey.

We compared two strategies for treating newborns with myeloschisis or myelomeningocele (open neural tube defect [oNTD]) and hydrocephalus. These strategies involved insertion of a ventriculo-peritoneal shunt (VPS) either synchronous with or sequential to surgical closure of the oNTD. We investigated shunt infection and cerebrospinal fluid (CSF) leakage rates and their effects on the duration of hospitalization for both treatments. The study involved 65 patients with hydrocephalus and open neural placodes which were covered with a thin pseudomembrane. Thirty-eight infants underwent an oNTD repair operation and shunting during the same surgical session (synchronous group [group 1]), and 27 infants underwent sequential procedures, in which shunt insertion was delayed until the thoracolumbar wound was partially healed (sequential group [group 2]). Group 1 had a mean duration of hospital stay of 15.5 days, significantly less than the average 28.8 days of group 2 (p < 0.05). No significant differences in CSF leakage and shunt infections occurred between the two groups (p > 0.05). The incidence of shunt infection due to CSF fistulas that developed postoperatively was higher for patients with CSF leakage as a result of oNTD at birth than for patients without CSF leakage (p < 0.05). Patients with oNTD are at significant risk of infections because of the thin pseudomembrane over the defect. In addition, newborn patients may also have a weakened immune system. Despite these disadvantages, VPS placement within a single session can be advantageous for the patient, family and physician, compared to multiple surgical procedures. It is also more cost-effective.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jocn.2010.03.042DOI Listing
December 2010

Meningioma causing hyperostosis of the cranial convexity in a child.

J Clin Neurosci 2010 Jul 21;17(7):926-9. Epub 2010 Apr 21.

Neurosurgery Clinic, Sişli Etfal Education and Research Hospital, Sişli, Istanbul, Turkey.

We present an 8-year-old girl with meningioma-associated hyperostosis. The patient was referred to our clinic due to headache and a frontoparietal midline swelling that was more prominent on the right side of the cranium. A cranial MRI revealed a frontoparietal parasagittal meningioma, accompanied by a diffuse hyperostosis, that appeared to extend extracranially. She underwent a right frontoparietal craniotomy and the tumor, together with the affected bone, was successfully removed. The histological examination confirmed meningioma (World Health Organization 2007 Grade 1) in the intracranial and extracranial lesions. Meningioma causing hyperostosis in a child is rare. The precise mechanism of hyperostosis associated with meningioma remains unclear; however, the most widely accepted theory is that the tumor invades the bone.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jocn.2009.11.008DOI Listing
July 2010

Pigmented villonodular synovitis of a lumbar intervertebral facet joint.

Spine J 2009 Aug 20;9(8):e6-9. Epub 2009 Mar 20.

Neurosurgery Clinic, Sişli Etfal Education and Research Hospital, Istanbul, Turkey.

Background Context: Pigmented villonodular synovitis (PVNS) is a slowly progressive lesion of uncertain etiology that involves the synovial membrane of joints or tendon sheaths. Only rarely does PVNS affect the axial skeleton, where it arises from the vertebral articular facet joint. Its treatment and prognosis remains limited.

Purpose: To describe our management in a patient with PVNS and to review previously published cases.

Study Design: Case report.

Methods: This is a case report of a 59-year-old woman who presented left sciatica. Computed tomography (CT) imaging revealed a mixed sclerotic and lucent lesion affecting the left L4-L5 facet joint. Magnetic resonance imaging (MRI) demonstrated a diffusely infiltrative process that originated from the left inferior articular process of L4 vertebra with extension into the spinal canal. A total synovectomy with left L4 hemilaminectomy was performed. Left L5 root was decompressed with total microscopic tumor removal. Decompression of spinal canal and absence of the tumor was shown by MRI and CT scan after the operation.

Results: Complete resolution of the patient's complaints was achieved. Histopathological analysis was consistent with a diagnosis of PVNS.

Conclusions: The principle of surgical management of spinal lesions causing neurologic deficit is early surgical decompression. It is also important to totally remove the synovium, the origin of PVNS, to prevent the recurrence.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.spinee.2008.12.010DOI Listing
August 2009

Transsellar transsphenoidal rhino-oral encephalocele.

Turk Neurosurg 2007 Oct;17(4):264-8

Sişli Etfal Education and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey.

Transsphenoidal encephaloceles are rare and the transsellar variety is the least common. We present a 1-year-old male patient with transsellar transsphenoidal encephalocele which herniated into the oral cavity through the congenital split palate. The patient was operated on using a combined transcranial and transpalatal approach without mortality or permanent morbidity. Clinical findings, imaging reviews, surgical repair techniques and postoperative morbidity are discussed with the relevant literature. We conclude that repair of a transsphenoidal encephalocele should be coordinated between a team of neurosurgeons and otorhinolaryngologists. Our surgical outcome supports a transcranial approach for the treatment of these difficult lesions, with transpalatal dissection and exposure.
View Article and Find Full Text PDF

Download full-text PDF

Source
October 2007