Publications by authors named "Ayhan Kanat"

93 Publications

The Influence of Music on Neurosurgical Cases: A Neglected Knowledge.

J Neurol Surg A Cent Eur Neurosurg 2021 Apr 12. Epub 2021 Apr 12.

Division of Neurosurgery, Department of Clinical Medicine, University Witten/Herdecke, Witten, Nordrhein-Westfalen, Germany.

Background:  The human brain can respond to and participate in music. Learning to play a musical instrument requires complex multimodal skills involving the simultaneous perception of several sensory modalities. In case of brain damage, the musician and nonmusician brains may have different capacities for reorganization and neural remapping. We aimed to investigate the effect of music on patients who had a brain tumor and/or underwent a neurosurgical procedure, comparing the recovery of those who had a musical background with those who did not.

Methods:  A literature review was performed to search for any evidence on this issue. We divided the cases into two groups: as group I consisted of the nonmusician patients, while group II consisted of musicians with a neurosurgical disease. Studies were rated from 0 (no effect) to 4 (high effect).

Results:  We found seven published studies as well as case reports. It was observed that the outcomes and quality of life of the musician group were better than those of the control groups or nonmusician patients in all of the investigated studies, but no statistical difference between musicians and nonmusicians was found.

Conclusion:  Music-related structural changes in the brain may occur in musicians. However with limited number of cases, it cannot be assorted the improved recovery in musicians after neurosurgical disease or procedures by his or her enhanced plasticity. There are limited number of cases, for that reason, it cannot be assorted the improved recovery in musicians after neurosurgical disease or procedures by his or her enhanced plasticity. Professional musicians, who are making a living through their musical abilities, may also have a strong motivation to undergo stressful and enduring rehabilitation. An early restart of the musical activity in musicians with neurosurgical disease may lead to better outcomes, better quality of life, and better psychological parameters, in a shorter time than in nonmusicians.
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http://dx.doi.org/10.1055/s-0040-1721017DOI Listing
April 2021

First emerging evidence of the relationship between Onuf's nucleus degeneration and reduced sperm number following spinal subarachnoid haemorrhage: Experimental study.

Andrologia 2021 Mar 23:e14030. Epub 2021 Mar 23.

Department of Urology, Medical Faculty of Recep Tayyip Erdogan University, Rize, Turkey.

Lumbosacral pathologies can lead to infertility. Onuf's nucleus changes in these pathologies may have a role in low sperm number. This study aims to investigate the relationship between Onuf's nucleus degeneration and sperm number following spinal subarachnoid haemorrhage. 22 rabbits were used. They were divided into three groups; five of them were used as the control (GI), five as the SHAM (GII) and twelve as the study groups (GIII). The study group received 0.7 ccs autologous blood into the spinal subarachnoid space at the T12-L1 level. After two weeks, all animals were decapitated, and S1-S3 laminectomy was done. Neurodegenerative changes of Onuf's nucleus, pudendal ganglia (S3) following two weeks after spinal SAH, were examined; sperm numbers were calculated. Degenerated neuron density of the Onuf's nucleus (n/mm ), the pudendal ganglia (S3) (n/mm ) and mean sperm numbers were calculated as 5 ± 2, 8 ± 3/mm and 98.345 ± 12.776/mm in the control (GI), 20 ± 5/mm , 243 ± 66/mm and 91.841 ± 9.654/mm in the SHAM (GII), 143 ± 39/mm , 2,350 ± 320/mm and 68.549 ± 5.540/mm in the study group (GIII). In conclusion, there were statistically significant differences between groups. Onuf's nucleus may be responsible for decreased sperm number following spinal SAH.
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http://dx.doi.org/10.1111/and.14030DOI Listing
March 2021

First emerging evidence of the relationship between Onuf's nucleus degeneration and reduced sperm number following spinal subarachnoid haemorrhage: Experimental study.

Andrologia 2021 Mar 23:e14030. Epub 2021 Mar 23.

Department of Urology, Medical Faculty of Recep Tayyip Erdogan University, Rize, Turkey.

Lumbosacral pathologies can lead to infertility. Onuf's nucleus changes in these pathologies may have a role in low sperm number. This study aims to investigate the relationship between Onuf's nucleus degeneration and sperm number following spinal subarachnoid haemorrhage. 22 rabbits were used. They were divided into three groups; five of them were used as the control (GI), five as the SHAM (GII) and twelve as the study groups (GIII). The study group received 0.7 ccs autologous blood into the spinal subarachnoid space at the T12-L1 level. After two weeks, all animals were decapitated, and S1-S3 laminectomy was done. Neurodegenerative changes of Onuf's nucleus, pudendal ganglia (S3) following two weeks after spinal SAH, were examined; sperm numbers were calculated. Degenerated neuron density of the Onuf's nucleus (n/mm ), the pudendal ganglia (S3) (n/mm ) and mean sperm numbers were calculated as 5 ± 2, 8 ± 3/mm and 98.345 ± 12.776/mm in the control (GI), 20 ± 5/mm , 243 ± 66/mm and 91.841 ± 9.654/mm in the SHAM (GII), 143 ± 39/mm , 2,350 ± 320/mm and 68.549 ± 5.540/mm in the study group (GIII). In conclusion, there were statistically significant differences between groups. Onuf's nucleus may be responsible for decreased sperm number following spinal SAH.
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http://dx.doi.org/10.1111/and.14030DOI Listing
March 2021

COVID-19 infection produces subarachnoid hemorrhage; acting now to understand its cause: A short communication.

Clin Neurol Neurosurg 2021 03 19;202:106495. Epub 2021 Jan 19.

Recep Tayyip Erdogan University, Medical Faculty Department of of Thoracic Surgery Rize, Turkey.

In the medical literature, some case reports on the association of the COVID-19 infection and occurrence of spontaneous subarachnoid hemorrhage (SAH)have been reported Aim of the present paper is to search the causes of this association The diagnosis of COVID-19 was based on the real-time reverse-transcription polymerase chain reaction (PCR) test and computed tomography (CT) of the chest. There were four patients, whose median ages were 46,758, ranged 36-54 years). In conclusion, Spontaneous SAH can occur in the early and late course of COVID-19 infection. Its early recognition of the patient with spontaneous SAH is imperative.
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http://dx.doi.org/10.1016/j.clineuro.2021.106495DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7817390PMC
March 2021

First histopathological bridging of the distance between Onuf's nucleus and substantia nigra after olfactory bulbectomy-new ideas about the urinary dysfunction in cerebral neurodegenerative disease: an experimental study.

Low Urin Tract Symptoms 2020 Dec 16. Epub 2020 Dec 16.

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

Objectives: Olfactory bulbectomy (OBX) in experimental studies induces neurochemical, neurodegenerative changes in various parts of the body. But no information is available about how OBX affects the spinal cord in rats. Our study aims to investigate this question.

Methods: Twenty-eight male rats were used. The rats were divided into three groups: six as the control, six as the SHAM, and 16 as the study group in which OBX was performed. The animals were followed for 10 weeks. After decapitation of the animals, olfactory bulb (OB) volumes, the olfactory glomerulus (OG), and the neuron density of the ON (Onuf nucleus) per cubic centimeter at the L4-S4 level were examined histopathologically and analyzed stereologically.

Results: The mean OB volume, remaining normal OG density, and degenerated neuron density (DND) of the ON was measured as 4.32 ± 0.21/mm , 1842 ± 114/mm , and 4 ± 1 /mm in the control (group I); 3.3 ± 0.14/mm , 1321 ± 114/mm , and 43 ± 8/mm in the SHAM (group II); and 1.672 ± 0.12/mm , 852 ± 93/mm , and 154 ± 11/mm in the study group (group III). There was a statistically significant difference between the SHAM and the study group (P < .05).

Conclusions: In this study, histopathological bridging between ON-related lower urinary tract symptoms (LUTS) and OBX was shown the first time. According to the findings, LUTS may be reversed by the protection of the affected spinal cord through the correction of olfaction impairment in neurodegenerative disease.
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http://dx.doi.org/10.1111/luts.12371DOI Listing
December 2020

Letter to the Editor Regarding the Manuscript of "The Longest Angiographic and Clinical Follow-Up of Microsurgically Treated Giant Intracranial Aneurysms: Experience with 70 Cases".

World Neurosurg 2020 08;140:462

Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II," Naples, Italy.

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http://dx.doi.org/10.1016/j.wneu.2020.05.179DOI Listing
August 2020

Estimating basilar artery upper rupture limit by dangerous alarming diameter of arteries (DADA) following bilateral common carotid artery ligation; a new theorem.

Int J Neurosci 2020 Aug 10:1-7. Epub 2020 Aug 10.

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

Background: Although many theories have been established to explain the mechanism of aneurysm development following steno-occlusive or hypertensive disease, the effect of the geometrical shape of the inner elastic membrane on the maximum dilatation capacity of arteries has not been adequately investigated so far. This subject was investigated.

Methods: This study was conducted in 24 rabbits. The rabbits were divided into 3 groups: as the control, ( = 5), the SHAM ( = 5), and the study group ( = 14). In the study group, BCCAL was performed. After decapitation, the basilar artery vasodilatation index (VDI) and the actual length of the inner elastic membrane (IEM) were estimated. The relationship between the true length of IEM and VDI values was compared statistically using the Mann-Witney -U test.

Results: Mean blood pressures were 113 ± 7 mmHg in animals at the beginning of the experiment ( = 24), and 119 ± 9 mmHg in GII and 122 ± 11mmHg in GIII after BCCAL ( = 12). Before decapitation, the mean blood pressures were 115 ± 10 mmHg in GI, 116 ± 10 mmHg in GII, and 127 ± 11mmHg GIII. The DADA values of animals were 20 ± 4mm in GI; 28 ± 6mm in GII and 37 ± 9mm in GIII. The VDI value of BA was 1.390 ± 0.220 in GI; 1.013 ± 0.108 in GI; 0.019 ± 0.011in GII group.

Conclusion: An inverse relationship was discovered between the DADA/VDI values. BCCAL may lead to severe dangerous histopathological changes at the BA. Lower DADA or higher VDI values may lead to severe basilar enlargement, endothelial losing, inner elastic membrane rupture, and aneurysm formation after BCCAL.
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http://dx.doi.org/10.1080/00207454.2020.1803303DOI Listing
August 2020

Important aspect of hypoglossal nerve injury following gunshot wound; Can the clivus has a role? A case report.

Br J Neurosurg 2020 Jul 11:1-2. Epub 2020 Jul 11.

Medical Faculty, Department of Radiology, Recep Tayyip Erdogan University, Rize, Turkey.

Cranial nerve palsies after gunshot injury are not uncommon. We report the mechanism of isolated hypoglossal nerve paralysis caused by a gunshot. We report a 74 years old patient in whom a bullet entered through the right nostril and then ended up right occipital condyle. The only neurologic deficit was tongue deviation which resolved in one week. The bullet was not removed. The effect of clival slope may have an importance in this type of injury.
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http://dx.doi.org/10.1080/02688697.2020.1777261DOI Listing
July 2020

A new experimental evidence that olfactory bulb lesion may be a causative factor for substantia nigra degeneration; preliminary study.

Int J Neurosci 2021 Mar 9;131(3):220-227. Epub 2020 Mar 9.

Medical Faculty Department of Neurology, Ataturk University, Erzurum, Turkey.

Anosmia has been considered as the first diagnostic criteria of Parkinson disease (PD), we investigated the effect of the olfactory bulbectomy (OBX) on histopathological features of the substantia nigra in an animal model. Twenty-seven male rats were used in this study. Animals were divided into three groups as five (control), six SHAM and sixteen study (OBL) groups. Nothing was done in the control group, the only burr hole was done in the SHAM group, OBL was not applied, and bilateral OBL was performed in the study group, and followed ten weeks, then animals were decapitated. Olfactory bulb volumes were measured by macro anatomically. The olfactory bulbs and substantia nigra sections were analyzed by a stereological method to evaluate olfactory glomerulus and neuron density of substantia nigra per cubic centimeter and compared with statistically. The mean olfactory bulb volume, degenerated olfactory glomerulus density and degenerated neuron density of substantia nigra were measured as:(4.14 ± 0.20) mm, (1 ± 1)/mm and (7 ± 2)/mm in control (Group I); (3.6 ± 0.16)/mm, (4 ± 1)/mm and(32 ± 7)/mm in SHAM (Group II) and (2.2 ± 0.9)/mm, (112 ± 18)/mm and (1543 ± 115)/mmin study group (Group III). Diminished olfactory bulb volume was observed in Group III animals. We concluded that OBL may lead to the degeneration of substantia nigra.
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http://dx.doi.org/10.1080/00207454.2020.1737049DOI Listing
March 2021

Rationalization of Using the MR Diffusion Imaging in B12 Deficiency.

Ann Indian Acad Neurol 2020 Jan-Feb;23(1):72-77

Department of Radiology, Medical Faculty, Recep Tayyip Erdogan University, Rize, Turkey.

Context: The structural imaging of brain does not demonstrate any changes in the vast majority of patients with vitamin B12 deficiency, even in the advanced stages.

Aims: We investigated the microstructural changes in the brain with diffusion imaging among patients with biochemical evidence of B12 deficiency.

Patients And Methods: We retrospectively analyzed all diffusion-weighted MRI images between the periods 2014-2016 who had biochemical evidence of B12. The age-sex matched controls were chosen from the group with normal B12 levels. Patients with pathological findings in conventional MRI images were excluded from the study.

Results: About 37 patients were recruited (22 women, 15 men; mean age, 34.1 ± 9.9 years; age range). They were about thirty-four age-and sex-matched controls (with normal B12 levels), which were also included in the study. The mean apparent diffusion coefficient (ADC) value of amygdala (773.8 ± 49.9 vs. 742.2 ± 24.2, = 0.01), hypothalamus (721.3 ± 39.2 vs. 700.2 ± 38.2, = 0.02), striate cortex (737.6 ± 77.6 vs. 704.3 ± 58.2, = 0.04), suprafrontal gyrus (740.7 ± 46.9 vs. 711.6 ± 40.7, = 0.007) and medulla oblongata-olivary nucleus (787.3 ± 56.4 vs. 759.7 ± 46.2, = 0.02) were significantly higher in B12 deficiency group compared to controls, whereas ADC values were similar at hippocampus, thalamus, insula, corpus striatum, cingulate gyrus, occipital gyrus, dentate nucleus, cerebral pedicle, tegmentum, pons, and posterior medulla oblongata.

Conclusions: Our study indicates that a significant increase in ADC values occurs in multiple brain regions in patients with vitamin B12.
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http://dx.doi.org/10.4103/aian.AIAN_485_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7001445PMC
February 2020

Recrudescence of the syringomyelia after surgery of Chiari malformation type 1 with duraplasty.

Br J Neurosurg 2020 Dec 20;34(6):697-700. Epub 2020 Jan 20.

Department of Neurosurgery, Medical Faculty, Recep Tayyip Erdoğan University, Merkez Rize, Turkey.

Few case reports describe an increase in the size of syringomyelia and the worsening of neurologic symptoms after surgery for foramen magnum decompression. We report three such cases. Retrospective review of patients with Chiari malformation (CM) and syringomyelia operated at the Erzurum Regional Hospital, Department of Neurosurgery between 1 January 2008 and 18 June 2018. A total of 118 patients were operated during the study period. Of the 118 patients, 81 were females, 37 were males. Ages range between 4 and 82 years, mean 38 years. Cervical or thoracic syringomyelia was found in 81 patients. Decompressive surgery with duraplasty was performed in all patients, and the patients were followed at least 2 years. The syrinx was the same or smaller in volume in 74 patients postoperatively, however, in three patients (3.7% of all patients with syringomyelia), the syrinx increased in volume. In this study, it was observed that an improvement or resolution of syringomyelia in 74 patients (91.3%) after decompression. There were no changes in the cavity in 4 and increased size in 3.
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http://dx.doi.org/10.1080/02688697.2020.1713991DOI Listing
December 2020

Interesting different survival status of musicians with malignant cerebral tumors.

Br J Neurosurg 2020 Jun 18;34(3):264-270. Epub 2019 Dec 18.

Faculty of Health, Department of Medicine, Witten/Herdecke University, Dean of Medical School Brandenburg Theodor Fontane, Neuruppin, Germany.

The education of a musician may have an effect on the neuronal functions and organization of the brain, promote brain plasticity, resulting in functional and structural changes. A variety of malign cerebral tumors have affected the musician, instrumentalist or singer, at some time during their lives. No comprehensive investigation for musicians with malignant tumors has been performed yet. The aims of the study are to investigate if there is a relationship between the performed music style (classic or pop/rock) and the malignancy of the tumor. The key words were 'neurosurgery and music' and the names of composers. We used digital catalogs like 'Pubmed' as well as the libraries of universities. We investigated a list of people with brain tumors from the English Wikipedia. (https://en.wikipedia.org/wiki/List_of_people_with_brain_tumors).We divided musicians into two groups according to their performing of classic or rock-pop music, and their gender. We found 27 classic and rock/pop musicians who suffered from malign cerebral tumors. The median survival time estimations were 18 (mean 22.33, 95% CI ranged from 7.49 to 37.17) months for pop-rock musicians and 8 (mean 8.67, 95% CI ranged from 4.13 to 12.19) months for classical music performers. However, in Cox regression analysis, performed classical music type was associated with an increased risk of early death, lesser survival time age associated with an adjusted hazard ratio (aHR) of 1.06 [95% confidence interval (CI) 1.020 to 1.111;  = .004), In musicians with malign cerebral tumors, music type performed by musician may affect the survival status, classical musicians have a worse outcome than rock-pop musicians.
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http://dx.doi.org/10.1080/02688697.2019.1701629DOI Listing
June 2020

New Histopathologic Evidence for the Parasympathetic Innervation of the Kidney and the Mechanism of Hypertension Following Subarachnoid Hemorrhage.

J Craniofac Surg 2020 May/Jun;31(3):865-870

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

Background: The Cushing response was first described in 1901. One of its components is elevated systemic blood pressure secondary to raised intracranial pressure. However, controversy still exists in its pathophysiologic mechanism. Hypertension is attributed to sympathetic overactivity and vagotomy increased renal-based hypertension. However, the role of the parasympathetic system in hypertension has not been investigated. This subject was investigated following subarachnoid hemorrhage (SAH).

Methods: A total of 24 rabbits were used: control group (n = 5), SHAM group (n = 5), and an SAH group (n = 14; bolus injection of blood into the cisterna magna). Blood pressures were examined before, during, and after the experiment. After 3 weeks, animals were decapitated under general anesthesia. Vagal nodose ganglion, axonal degeneration, and renal artery vasospasm (RAV) indexes of all animals were determined histopathologically.

Results: Significant degenerative changes were detected in the vagal axons and nodose ganglia following SAH in animals with severe hypertension. The mean degenerated neuron density of nodose ganglions, vasospasm index (VSI) values of renal arteries of control, SHAM, and study groups were estimated as 9.0 ± 2.0 mm, 1.87 ± 0.19; 65.0 ± 12.0 mm, 1.91 ± 0.34; and 986.0 ± 112.0 mm, 2.32 ± 0.89, consecutively. Blood pressure was measured as 94.0 ± 10.0 mmHg in control group, 102.0 ± 12.0 mmHg in SHAM; 112.0 ± 14.0 mmHg in middle (n = 9); and >122.0 ± 10.0 mmHg in severe RAV-developed animals (n = 5). Differences VSI values and blood pressure between groups were statistically significant (P < 0.05).

Conclusion: The degeneration of vagal nodose ganglion has an important role in RAV and the development of RAV and hypertension following SAH.
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http://dx.doi.org/10.1097/SCS.0000000000006041DOI Listing
August 2020

Our Final Response Concerning the Article Entitled "Aneurysm Clip Compression Technique in the Surgery of Aneurysms with Hard/Calcified Neck".

World Neurosurg 2019 08;128:639-640

Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy.

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http://dx.doi.org/10.1016/j.wneu.2019.05.150DOI Listing
August 2019

What Are We Missing From Asymmetric Relationship Between the Retinal Nerve Fiber Layer Thickness Profiles and Sphenoid Sinus Volume?

J Craniofac Surg 2020 Mar/Apr;31(2):e210-e214

Department of Otorhinolaryngology, Medical Faculty.

Purpose/aim Of The Study: Detailed analysis of retinal structure such as the retinal nerve fiber layer can be performed by spectral-domain optical coherence tomography (OCT). There are no published studies concerning a relationship between retinal nerve fiber layer and human sphenoid sinus volumes. We investigated this relationship.

Material And Methods: Spectral-domain OCT. The peripapillary retinal nerve fiber layer (RNFL) thickness and sphenoid sinus volume estimation of both sides of sex-matched patients were retrospectively analyzed.

Results: The mean RNFL thicknesses at the left side (91.8 μm) were significantly smaller than the right side (94.5 μm) (P = 0.040). However, the mean left sinus volume (44.5 cm) is larger than the right side, (34.5 mm) (P < 0.005). Left and right differences of both parameters are statistically significant (P < 0.05).

Conclusion: There is a negative correlation between mean RNFL thicknesses and mean sinus volumes. To our knowledge, this article is the first report demonstrating the asymmetry relationship between RNFL and sphenoid sinus volumes.
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http://dx.doi.org/10.1097/SCS.0000000000005909DOI Listing
July 2020

Water-Filled Vesicles of Choroid Plexus Tumors.

J Craniofac Surg 2019 Oct;30(7):2171-2173

Erzurum Training and Research Hospital Neurosurgery Clinic, Erzurum.

Objective: Choroid plexus cysts are the most common neuro-epithelial cysts.

Methods: The authors describe 2 cases. The first case is a 1-year-old child presenting with hydrocephalus and cyst of the choroid plexus. The child was treated with endoscopic fenestration of the cysts.

Results: The histological examination of the cyst wall was consistent with choroid epithelium and water-filled vesicles. The second case is a 63 year old male with a highly vascularized tumor extending to choroid plexus. A quaductus Silvius was obstructed by the tumor. The histopathologic examination of choroid plexus showed a low number, water-vesicles.

Conclusions: According to our knowledge, there are no previous reports of water-filled vesicles with choroid plexus cyst causing hydrocephalus. The first case is a good example of over secretion of cerebrospinal fluid (CSF) with the water-filled vesicle. The second case with low number of water filled vesicle shows that the cause of hydrocephalus is not over production of CSF, it is blockage of the CSF pathway in Aquaductus Silvius by the tumor itself. These 2 cases are illustrative and more importantly highlight the need to study for water-filled vesicles in these kind of cases.
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http://dx.doi.org/10.1097/SCS.0000000000005735DOI Listing
October 2019

Describing a New Mechanism of Retinal Detachment Secondary to Ophthalmic Artery Vasospasm Following Subarachnoid Hemorrhage: An Experimental Study.

J Neurol Surg A Cent Eur Neurosurg 2019 Nov 20;80(6):430-440. Epub 2019 Aug 20.

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

Background:  The pterygopalatine ganglion (PPG) and ophthalmic arteries (OpAs) have important roles in ocular autoregulation and retinal and visual functions. The relationship between PPG neuron density, OpA vasospasm, and retinal detachment in subarachnoid hemorrhage (SAH) has never been studied.

Methods:  This study was conducted on 25 rabbits. Five animals were in the control group (GI;  = 5), five in the sham group (GII;  = 5), and 15 in the study group (GIII;  = 15). After injection of 1 cc serum saline into the cisterna magna in the sham group, and autologous blood in the SAH group, the animals were followed for 3 weeks. All animals underwent a retinal examination five times a week for 3 weeks before and after the experiment. After the experiment, the neuron density of PPGs of the facial nerves, vasospasm index (VSI) of OpAs, and total basal surface values of the detached retinal parts (DRPs) were calculated.

Results:  In the funduscopic examination, intravitreous hemorrhage ( Terson's syndrome) was detected in four animals in the SAH group. In the control groups, neuron density was 12,000 ± 1,240/mm, VSI = 0.345 ± 0.076, and DRP = 0 to 1.5 mm. Mean neuron density was 9,450 ± 940/mm, VSI = 1.645 ± 0.940, and DRP = 6.23 ± 1.61 mm in the sham group ( < 0.05). Neuron density was 6,890 ± 932/mm, VSI = 2.92 ± 0.97, and DRP = 9.43 ± 2.54 mm in SAH group.

Conclusion:  Mean neuron density, VSI of OpAs, and DRP values differed statistically significant between the SAH group and other groups ( < 0.005). There is an inverse relationship between PPG neurons and DRP. However, a direct relationship was observed between the mean VSI and DRP values.
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http://dx.doi.org/10.1055/s-0039-1685186DOI Listing
November 2019

The Effect of Neuroscientists on the Studies of Autonomic Nervous System Dysfunction Following Experimental Subarachnoid Hemorrhage.

J Craniofac Surg 2019 Oct;30(7):2184-2188

Medical Faculty, Department of Neurosurgery, Karadeniz Technical University, Trabzon, Turkey.

Objective: The autonomic nervous system dysfunctions following subarachnoid hemorrhage (SAH) are common in neurosurgical clinical practice. The aim of the study is to investigate the effect of Asian neuroscientists on the studies of autonomic nervous system dysfunction following experimental subarachnoid hemorrhage.

Methods: A systematic search was conducted using the MEDLINE and Web of Science databases for studies pertaining to SAH and autonomic nervous system dysfunction. The searched terms contained "experimental subarachnoid hemorrhage," "autonomic nervous system," and "Ganglion."

Results: There are many animal studies because the live human brain vessels cannot be used in investigations. The considerable efforts have been made to investigate the effect of SAH on the autonomic nervous system in laboratory animals. Seventy-four studies were published by various authors. Most of the articles came from Asian Countries 49 studies (66.2% of the total studies). The most preferred animals were rabbits (in 43 studies, 58.1% of the total studies).

Conclusion: Asian neuroscientists published enormous contributions in SAH-related autonomic nervous system dysfunction. It was shown that there is a great interest of Asian neuroscientists for autonomic nervous system changes secondary to SAH.
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http://dx.doi.org/10.1097/SCS.0000000000005763DOI Listing
October 2019

New insights of the fever following subarachnoid hemorrhage and introducing a new thermoregulator like structure in choroid plexuses; preliminary study.

Acta Neurol Taiwan 2019 Mar;28(1):1-11

Ataturk University, Medical Faculty Department of Pathology Erzurum Turkey.

Objective: Vagal nerves and their thermoreceptors could regulate temperature of brain. Cerebrospinal fluid (CSF) is increased in the early phases of subarachnoid hemorrhage (SAH). We hypothesised that choroid plexuses probably innervated by vagal nerves may play a role on the regulation of brain temperature and studied this subject.

Methods: This study was conducted on 32 rabbits, divided into four groups, with five rabbits in the control group (group I), five rabbits in the sham group (Group II), and 22 rabbits in the SAH group. In the SAH group, 7 of the animals were decapitated after 7 days of cisternal blood injections (Group III), and the other 15 animals were decapitated after 21 days of injections (Group IV). Brain temperature via laser thermometer 5 times a day during the experiment was measured. Normal and degenerated neuron density of nodose ganglia, water vesicles numbers of choroid plexuses were stereologicallyanalyzed. Statistical analysis was performed.

Results: At histopathologic analysis of present study, thermo regulator like structure was noted and the mean number of this structure was estimated.The mean number of water-filled vesicles, thermo regulator like structure, in SAH-induced animals,brain temperature and degenerated neuron density of nodose ganglia was statistically different between the early decapitated group (group III) and the late decapitated group (group IV) (P less then 0.05).

Conclusions: We introduce a thermo regulator like structure, describe a new syndrome. In addition, it was noted thatwater-filled vesicles of CP are increased, brain temperature in nearly normal in the early phase of SAH due to likely irritation of vagal nerves. However in the late phase, mean number of water-filled vesicles numbers decreased in accordance with increased brain temperature with degenerative changes of the nodose ganglion.
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March 2019

Toward understanding the causes of blood pH irregularities and the roles of newly described binuclear neurons of carotid bodies on blood pH regulation during subarachnoid hemorrhage: Experimental study.

Neuropathology 2019 Aug 10;39(4):259-267. Epub 2019 May 10.

Department of Psychiatry, Bakirkoy Mental Diseases Education Hospital, İstanbul, Turkey.

Acidosis is the most dangerous complication of subarachnoid hemorrhage (SAH). Although the carotid bodies (CBs) network is essential for pH regulation, neither binuclear neurons (BNN) nor their functions have been mentioned so far in the literature. The aim of this study was to investigate the crucial roles of mononuclear (MNN) or BNN in CBs on acidosis following SAH. Twenty-five hybrid rabbits were used. Five rabbits were used as a control group, six for sham, and the remaining 14 rabbits were used as the study group by injection of 1 mL of autologous arterial blood into the cisterna magna to produce SAH. Normal and degenerated MNN/BNN densities of CBs were counted by stereological methods. The mean blood pH values were: 7.362 ± 0.041 in the control group; 7.324 ± 0.064 in sham, 7.272 ± 0.062 in the SAH group. The degenerated MNN and BNN values were 5 ± 1/mm and 9 ± 3/mm in the control group; 15 ± 5/mm and 22 ± 6/mm in sham, 965 ± 113/mm and 1532 ± 176/mm in the SAH group. Mean pH values were under 7.212 ± 0.130 in animals with prominent degenerated BNN. The differences between MNN/pH changes were significant between the SAH and control groups (P < 0.005); whereas BNN/pH values were significant between the SAH and sham groups (pH < 0.005), SAH and control (P < 0.0001). BNN degeneration could result in more severe acidosis than MNN following SAH which has not been described so far.
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http://dx.doi.org/10.1111/neup.12552DOI Listing
August 2019

A different aspect of the unexpected death of Mozart at the age of 35 years.

CNS Spectr 2019 12;24(6):628-631

President of Brandenburg Medical School - Theodor Fontane, Campus Neuruppin, Germany and Senior Professor of Health Services Research at Witten/Herdecke University, Germany.

The cause of the early death of Wolfgang Amadeus Mozart (1756-1791) at the age of 35 has been the source of much discussion in the medical community. Investigators attributed to Mozart nearly 150 different medical diagnoses. However, the neurosurgical aspect of the early death of Mozart has yet to be well-analyzed, and this subject was investigated herein. The key words "Mozart" and "Mozart's death" were searched in PubMed as well as the libraries of universities. The main source was the archive and website of Internationale Stiftung MOZARTEUM/Salzburg (www.mozarteum.at) and the cranium stored in the Internationale Stiftung Mozarteum in Salzburg/Austria. The linear fracture of the cranium is important, since it shows the neurosurgical aspect of the early death of Mozart. Mozart's disease was most likely a neurotraumatologic one. His fracture likely occurred several months before his death, as evidenced by signs of healing. Intense headaches and declining musical performance in his last year may have been influenced by intracranial hemorrhage induced by the linear fracture. His final disease therefore may have been chronic postconcussion syndrome depending on chronic calcified epidural hematoma.
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http://dx.doi.org/10.1017/S1092852918001736DOI Listing
December 2019

Spinal Subarachnoid Hemorrhage Induced Intractable Miotic Pupil. A Reminder of Ciliospinal Sympathetic Center Ischemia Based Miosis: An Experimental Study.

Turk Neurosurg 2019 ;29(3):434-439

Ataturk University, Faculty of Medicine, Department of Neurosurgery, Erzurum, Turkey.

Aim: To examine ischemic neurodegeneration of the ciliospinal center on permanent miosis following subarachnoid hemorrhage (SAH).

Material And Methods: Nineteen rabbits were examined in this study. The animals were divided into three groups, as control (GI, n=5), sham (GII, n=5) and study group (GIII, n=9). Pupil diameters were measured after giving 0.5 mL physiological saline for sham and autologous arterial blood for the study group into the cervico-thoracic subarachnoid space. After three weeks of follow up, the cervico-thoracic cord and bilateral superior cervical sympathetic ganglia were removed. The pupil diameter values were compared with degenerated neuron volumes of sympathetic ganglia and degenerated neuron densities of thoracic sympathetic nuclei which were studied by stereological methods.

Results: The mean pupil diameter was 5180 ± 370 µm and the mean degenerated neuron density of the ciliospinal center was 4 ± 1/mm3 in animals of the control group (GI). These values were 9850 ± 610 εm, 10 ± 3/mm3 in sham (GII), and 7.010 ± 440 εm and 98 ± 21/mm3 in the study (GIII) groups. There was an inverse relationship between degenerated neuron density of the ciliospinal nuclei and pupil diameters.

Conclusion: We showed and reported for the first time that ciliospinal sympathetic center ischemia-induced neurodegeneration may have been responsible for permanent miosis following SAH.
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http://dx.doi.org/10.5137/1019-5149.JTN.24446-18.1DOI Listing
October 2019

Brachial Artery Vasospasm Caused by Cervical Dorsal Root Ganglion Degeneration After Subarachnoid Hemorrhage: An Experimental Study.

World Neurosurg 2019 Jun 11;126:e895-e900. Epub 2019 Mar 11.

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

Purpose: Subarachnoid hemorrhage (SAH) may lead to vasospasm in various vessels. The cervical nerves have a vasodilatory effect on the upper extremity arteries. The aim of this study was to investigate if there is a relationship between C6 dorsal root ganglion (DRG) degeneration and brachial artery (BA) vasospasm after spinal SAH.

Methods: This experimental study was conducted on 23 rabbits. The animals were divided into 3 groups: control (n = 5), SHAM (n = 5), and study group (n = 13). One cubic centimeter (cc) of serum saline was injected into the cisterna magna of animals of the SHAM group; the same procedure was performed by 1 cc of homologous blood in the study group. Degenerated neuron densities (DNDs) of DRGs (n/mm) at C6 levels and BA vasospasm indexes (VSI; wall surface/lumen surface) of all animals were determined and results were analyzed statistically.

Results: Mean VSI values of BAs and DNDs of CDRGs of the control, SHAM, and study groups were estimated as 10 ± 3/1.12 ± 0.11 n/mm, 34 ± 9/1.27 ± 0.24 n/mm, and 1031 ± 145/2.93 ± 0.78 n/mm, respectively. Mean DNDs and VSI values were statistically significantly different between the control and study groups (P < 0.0001).

Conclusions: CDRG degeneration may be considered as an important factor in the etiopathogenesis of severe BA vasospasm after SAH.
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http://dx.doi.org/10.1016/j.wneu.2019.03.007DOI Listing
June 2019

Paradoxic Relations between Basilar Artery Reconfiguration and Superior Cervical Ganglia Ischemia After Bilateral Common Carotid Artery Ligation.

World Neurosurg 2019 05 1;125:e658-e664. Epub 2019 Feb 1.

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

Background: The relationship between superior cervical ganglia (SCG) ischemia due to bilateral common carotid artery ligation (BCCAL) and basilar artery (BA) reconfiguration was investigated.

Methods: Twenty-three rabbits were randomly divided into 3 groups: group III rabbits underwent BCCAL (n = 13), group II rabbits were sham-operated controls (n = 5), and group I rabbits did not undergo surgery (n = 5). Degenerated neuron densities (DND) within the SCG were correlated with the BA vasodilatation index (VDI).

Results: Mean live and DND in SCG of group I rabbits were 11.235 ± 982/μm and 11 ± 3/μm, respectively, with a mean heart rate of 294 ± 21 beats/min. Mean SCG DND and heart rates were 213 ± 42/μm and 242 ± 17 beats/min for the sham group (group II) rabbits and 1743 ± 285/μm and 199 ± 19 beats/min for the study group (group III) rabbits, respectively. The BA VDI values in the sham group (group II) (1.32 ± 0.10) and the study group (group III) (0.976 ± 0.112) significantly differed from those in the control group (group I) (1.65 ± 0.12; P < 0.005) versus the sham group (group II) (P < 0.0001) versus the BCCAL applied group (group III) and between group II and group III (P < 0.005).

Conclusions: A meaningful and paradoxic correlation was detected between the BA VDI values and degenerated neuron density of SCG after BCCAL. Although a low degenerated neuron density within SCG may provoke excessive sympathetic activity and prevent excessive BA dilatation with steno-occlusive carotid artery diseases, a high degenerated neuron density may cause dangerous vasodilatation of BA.
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http://dx.doi.org/10.1016/j.wneu.2019.01.144DOI Listing
May 2019

Sciatic nerve injury following analgesic drug injection in rats: A histopathological examination.

North Clin Istanb 2018 Sep;5(3):176-185

Department of Neurology, Medeniyet University Faculty of Medicine, Istanbul, Turkey.

Objective: Sciatic nerve neuropathy can be observed following intramuscular gluteal injections. The histopathological examination of sciatic nerve damage following intramuscular injection in the gluteal region for acute pain treatment is not feasible in humans due to the inability to dissect and examine the nerve tissue. To overcome this issue, we used a rat model for demonstrating damage to the sciatic nerve tissue after the application of commonly used drug injections.

Methods: We investigated possible damage following the intramuscular injection of diclofenac, lornoxicam, morphine, and pethidine in a rat model based on histopathological characteristics such as myelin degeneration, axon degeneration, epineurium degeneration, fibrosis, epineurium thickening, perineurium thickening, lymphocyte infiltration, vacuolization, and edema.

Results: All the analgesic drugs used in our study induced histopathological changes in the sciatic nerve. Anti-S100 positivity, showing nerve damage, was found to be the lowest in the group treated with diclofenac. Neurotoxic effects of diclofenac on the sciatic nerve were greater than those of the other drugs used in the study. Lornoxicam induced the least histopathological changes in the nerve.

Conclusion: Diclofenac induced severe nerve damage not only after direct injection in the sciatic nerve but also after injection in the area around the nerve. Thus, we recommend restricting the use of intramuscular gluteal injections of diclofenac. Intramuscular use of morphine and pethidine should also be overviewed.
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http://dx.doi.org/10.14744/nci.2017.28190DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6323560PMC
September 2018

First emerging objective experimental evidence of hearing impairment following subarachnoid haemorrhage; Felix culpa, phonophobia, and elucidation of the role of trigeminal ganglion.

Int J Neurosci 2019 Aug 21;129(8):794-800. Epub 2019 Feb 21.

h Department of Neurosurgery , Okmeydanı Training and Research Hospital , Istanbul , Turkey.

The exact mechanism of phonophobia induced by subarachnoid hemorrhage (SAH) has not been understood well. This subject was investigated. This study was conducted on 25 rabbits. They divided into three groups: Five as control, five as SHAM, 20 as SAH group. All animals objected to 85 dB impulse noise by daily periods, and their phonophobic score values were examined by daily periods for 20 days. Their brains, trigeminal ganglia were extracted bilaterally. The normal and degenerated neuron densities of trigeminal ganglia were examined by stereological methods and compared with phonophobia scores. Phonophobic score was 19-17, mean live neuron density (LND) of the trigeminal ganglia was 16.321 ± 2.430/mm, and degenerated neuron density (DND) was 1.15 ± 0.120/mm in animals of control groups ( = 5). The phonophobic score was 17-14, LND: 14.345 ± 1.913/mm, DND of the trigeminal ganglia was 1.150 ± 0.110/mm in SHAM group ( = 5). The phonophobic score was 14-8, LND: 12.987 ± 1.966/mm, mean DND of the trigeminal ganglia was 2.520 ± 510/mm in animals with high phonophobia scores ( = 6). The phonophobic score was 7-4, LND: 9.122 ± 1.006, mean DND of the trigeminal ganglia was 5.820 ± 1.610/mm, in animals with fever phonophobia scores ( = 9). An inverse relationship between DND trigeminal ganglion (TGG) and phonopobic score was found. The paralysis of tensor tympani muscle owing to trigeminal ganglia ischemia may be responsible for phonophobic clinical state in animals with SAH. In addition, there seems to be an important concern for the verbal component of GCS in SAH. These two important findings have not been published previously.
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http://dx.doi.org/10.1080/00207454.2019.1569651DOI Listing
August 2019

In Reply to the Reply to the Letter to the Editor Regarding "Aneurysm Clip Compression Technique in the Surgery of Aneurysms with Hard/Calcified Neck".

World Neurosurg 2019 01;121:279

Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy.

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http://dx.doi.org/10.1016/j.wneu.2018.08.090DOI Listing
January 2019

In Reply to 'Second Response to Second Criticism Concerning Our Article Entitled "Aneurysm Clip Compression Technique in the Surgery of Aneurysms with Hard/Calcified Neck"'.

World Neurosurg 2018 12;120:607-608

Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli "Federico II", Naples, Italy.

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http://dx.doi.org/10.1016/j.wneu.2018.09.171DOI Listing
December 2018

In Reply to "Hypothesis on the Origin of Dance: Mirror Neuron System and Imitation From Movement Disorders".

World Neurosurg 2018 12;120:605

Department of Health Services Research, Witten/Herdecke University, Department of Medicine, Faculty of Health, Universität Witten/Herdecke, Neuruppin, Germany.

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http://dx.doi.org/10.1016/j.wneu.2018.09.162DOI Listing
December 2018