Publications by authors named "Ercan Tureci"

15 Publications

  • Page 1 of 1

Single-stage planning for total cure of grade III-V brain arteriovenous malformations by embolization alone or in combination with microsurgical resection.

Neuroradiology 2019 Feb 28;61(2):195-205. Epub 2018 Nov 28.

Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

Purpose: There are no established guidelines for treatment of Spetzler-Martin grade III-V brain arteriovenous malformations (bAVMs). The purpose of this study is to report our institutional experience in total obliteration/eradication of grade III-V bAVMs by single-stage planning of embolization combined with microsurgical resection when necessary.

Methods: All patients harboring Spetzler-Martin (S-M) grade III-V bAVMs treated with single-stage planning between January 2006 and January 2018 were retrospectively reviewed. This treatment paradigm is applicable only to surgically accessible bAVMs and does not include deep-seated bAVMs. Indications for treatment, clinical presentation, imaging characteristics, and treatment outcomes were analyzed. Outcomes were assessed based on modified Rankin Scale.

Results: A total of 31 patients were identified. Seventeen patients (54.8%) presented with hemorrhage, 10 (32.3%) with seizures, 3 (9.7%) with headaches, and 1 (3.2%) with progressive neurological deficit. Based on S-M grading system, 25 patients (80.6%) harbored grade III bAVM, 5 patients had grade IV bAVMs (16.1%), and 1 patient (3.2%) had a grade V bAVM. There were no treatment-related complications in 24/31 (77.4%) patients. Of the total of seven patients with complications, four patients had clinical deterioration. The long-term (> 6-month), non-disabling morbidity (mRS ≤ 2) rate was 6.5%. The long-term, disabling morbidity rate was 3.2% with a mortality of 3.2%. Complete angiographic obliteration was achieved in 30/31 (96.8%) patients.

Conclusion: Single-stage treatment strategy can be considered as an alternative to multistage embolization prior to surgery in grade III-V bAVMs. In this study, a high rate of total obliteration with relatively low rates of permanent morbidity and mortality was achieved.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00234-018-2140-zDOI Listing
February 2019

Flow Re-direction Endoluminal Device in treatment of cerebral aneurysms: initial experience with short-term follow-up results.

J Neurosurg 2014 May 14;120(5):1158-71. Epub 2014 Mar 14.

Division of Neuroradiology, Department of Radiology, and.

Object: Flow diverter (FD) stents are relatively new and important devices in the treatment of cerebral aneurysms. The Flow Re-Direction Endoluminal Device has been recently released for clinical use. The authors' aim in this paper is to report their initial single-center FRED experience with short-term results.

Methods: Between February 2012 and May 2013, 33 patients with 37 aneurysms (35 unruptured and 2 previously ruptured aneurysms) were treated with the FRED. Clinical and radiological data of the patients were retrospectively reviewed.

Results: In all patients only 1 device was used without any additional device or material, such as a stent or coil. All procedures were successfully performed. The procedural complication rate was 3% (1 of 33). Thirty patients underwent clinical and radiological follow-up. During the follow-up period, changes in stent morphology, such as "fish mouth" and "foreshortening" phenomena, occurred in 5 patients. The mortality and permanent morbidity rates were 0%. The complete occlusion rates were 32% (6 of 19) at 0-1 month, 67% (8 of 12) at 2-3 months, 80% (4 of 5) at 4-6 months, and 100% (8 of 8) at 7-12 months. The rates for some aneurysms were assessed at more than one time point.

Conclusions: The FRED has an ability to serve neurointerventionalists in the treatment of cerebral aneurysms with its different technical advantages. The occlusion rates with FRED are similar to those with other FD devices. However, these short-term results need to be confirmed with mid- and long-term follow-up results of multicenter large series.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3171/2014.1.JNS131442DOI Listing
May 2014

How analgesia-sedation alters monocyte mCD14 and HLA-DR levels in patients undergoing cerebral angiography?

Turk Neurosurg 2013 ;23(6):791-5

Istanbul University, Cerrahpasa Medical Faculty, Department of Physiology, Istanbul, Turkey.

Aim: This study aims to evaluate how analgesia-sedation causes alterations of HLA-DR and cytokines (IL-10 and IL-6) in patients undergoing cerebral angiography for several cerebral vascular diseases.

Material And Methods: This study includes 41 males who underwent cerebral angiography. The study sample was divided into two: Group I had 7 patients who did not receive and group II had 34 patients who received analgesia-sedation before cerebral angiography. A venous blood sample was collected before and after cerebral angiography.

Results: Analgesia-sedation caused significant increase CD4+ and CD19 T lymphocytes (p < 0.001) but group I showed significant increase in CD40, CD154, and MHC-II levels (p < 0.001) after cerebral angiography.

Conclusion: We suggest that the effects of fentanyl and midazolam on the immune response are the reflection of the effects by the monocyte, mHLA-DR expression. In the future, depending on the immunological status of the patients, different anesthetic applications including the new anesthetic agents that will be able to decrease immune system suppression will be required.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5137/1019-5149.JTN.8218-13.0DOI Listing
July 2014

Dissecting aneurysms of posterior communicating artery itself: anatomical, diagnostic, clinical, and therapeutical considerations.

Neuroradiology 2013 Sep 21;55(9):1103-12. Epub 2013 Jun 21.

Cerrahpasa Medical Faculty, Department of Radiology, Division of Neuroradiology, Istanbul University, Istanbul, 34098, Turkey.

Posterior communicating artery (PCoA) itself is an unusual location for intracranial aneurysms in that isolated dissections or dissecting aneurysms are extremely rare. In the way of correct diagnosis of dissecting aneurysms of PCoA itself, a proper understanding of (1) the anatomy of the PCoA and its perforator branches, (2) some particular diagnostic features, and (3) related clinical aspects is of significant importance. Although there are no established treatment strategies for this particular type of aneurysms, the endovascular approach might be considered as a plausible one. In this paper, our scope was to report five cases with dissecting aneurysm of the PCoA itself and to discuss this rare vascular pathology from anatomical, diagnostic, clinical, and therapeutical perspectives.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00234-013-1212-3DOI Listing
September 2013

Endovascular treatment of carotid cavernous sinus fistula: A systematic review.

World J Radiol 2013 Apr;5(4):143-55

Bora Korkmazer, Burak Kocak, Civan Islak, Naci Kocer, Osman Kizilkilic, Division of Neuroradiology, Department of Radiology, Cerrahpasa School of Medicine, Istanbul University, 34098 Istanbul, Turkey.

Carotid cavernous sinus fistulas are abnormal communications between the carotid system and the cavernous sinus. Several classification schemes have described carotid cavernous sinus fistulas according to etiology, hemodynamic features, or the angiographic arterial architecture. Increased pressure within the cavernous sinus appears to be the main factor in pathophysiology. The clinical features are related to size, exact location, and duration of the fistula, adequacy and route of venous drainage and the presence of arterial/venous collaterals. Noninvasive imaging (computed tomography, magnetic resonance, computed tomography angiography, magnetic resonance angiography, Doppler) is often used in the initial work-up of a possible carotid cavernous sinus fistulas. Cerebral angiography is the gold standard for the definitive diagnosis, classification, and planning of treatment for these lesions. The endovascular approach has evolved as the mainstay therapy for definitive treatment in situations including clinical emergencies. Conservative treatment, surgery and radiosurgery constitute other management options for these lesions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4329/wjr.v5.i4.143DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3647206PMC
April 2013

Carotid stenting with low-dose contrast medium for patients with moderate-to-severe chronic renal insufficiency: keyhole carotid stenting.

Eur J Radiol 2013 Mar 22;82(3):508-11. Epub 2012 Oct 22.

Istanbul University, Cerrahpasa Medical Faculty, Department of Radiology, Division of Neuroradiology, Kocamustafapasa, Istanbul 34098, Turkey.

Herein, we describe a new carotid stenting approach for four patients with moderate-to-severe chronic renal insufficiency, who have a glomerular filtration rate (GFR) between 15 and 59 mL/min/1.73 m(2), using a minimum dose of contrast medium (12 mL at a 50% dilution) and SmartMask™ technology as an alternative to carotid endarterectomy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejrad.2012.08.025DOI Listing
March 2013

Early and midterm results of complex cerebral aneurysms treated with Silk stent.

Neuroradiology 2012 Dec 14;54(12):1355-65. Epub 2012 Jun 14.

GATA Haydarpasa Teaching Hospital Department of Radiology, Istanbul, Turkey.

Introduction: Endovascular treatment of intracranial aneurysms has been an effective treatment option. In this paper, we report our experience with the Silk stent (SS) for endovascular treatment of complex intracranial aneurysms and present periprocedural events, immediate results, delayed complications, and imaging and clinical follow-up results.

Methods: We retrospectively examined angiographic images and clinical reports of 76 consecutive patients with 87 intracranial aneurysms who were treated with SSs between March 2008 and June 2011.

Results: All aneurysms could be successfully covered technically using implanted SSs, with an overall mortality of 6.6 %. Two transient morbidities (2.6 %) and three permanent morbidities due to embolic events (3.9 %) were observed. Unexpected procedural technical events occurred in 18 procedures (18/78, 23.1 %). Control angiographies were performed in all 71 patients with 82 aneurysms (100 %). Mean angiographic follow-up time was 17.5 ± 11.1 months [range 2-48 months]. Sixteen of the 71 patients with 19 aneurysms had only early angiographic controls in the first 6 months while remaining 55 patients with 63 aneurysms (77.5 %) had late controls after 6 months. Overall control angiographic occlusion rates were as follows: 87.8 % (72/82) total occlusion, 8.5 % residual aneurysm filling, and 3.7 % residual neck filling. The general in-stent stenosis rate in controls was 5.6 % and the stented parent artery occlusion rate was 4.2 %. Five (6.6 %) aneurysms ruptured after stent implantation in our series.

Conclusion: The Silk stent is an effective tool for the treatment of challenging aneurysms, which have previously demonstrated higher re-growth rates and technical problems, despite unexpected higher hemorrhage rates after treatment and deployment difficulties.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00234-012-1051-7DOI Listing
December 2012

Neurosurgery in the sitting position: retrospective analysis of 692 adult and pediatric cases.

Turk Neurosurg 2011 ;21(4):634-40

Istanbul University, Cerrahpasa Faculty of Medicine, Department of Anesthesiology and Intensive Care, 34098 Istanbul, Turkey.

Aim: The sitting position is routinely used in many centers, although its use remains controversial and appears to be diminishing because of the risk of venous air embolism (VAE).

Material And Methods: This is a retrospective analysis of 601 adult and 91 pediatric cases underwent neurosurgery from January 1995 through December 2010 in the sitting position. The incidence of VAE and other complications related to the sitting position has been determined. VAE was defined as a sudden and sustained decrease of end-tidal carbon dioxide (ETCO2) ≥0.7 kPa.

Results: The incidence of VAE in children and adults were found to be 26.3% (n=24) and 20.4% (n=123) consecutively but the difference was not significant. The incidence of positioning induced hypotension was more in adults (37.6%) compared to children (18.6%, p=0.00001). The presence of COPD (p=0.04) and ASA status (p=0.03) showed a correlation with 'hypotension with positioning'. There was no peroperative mortality.

Conclusion: The study provides a significant body of data on neuroanesthesia for the sitting position and our results suggest that if the sitting position is a neurosurgical necessity it can be used with vigilant follow up throughout the procedure to detect any occurrence of VAE by ETCO2 monitoring if you do not have the chance to use more sensitive tools.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5137/1019-5149.JTN .4974-11.0DOI Listing
April 2012

The effects of analgesia-sedation on the immune system before and after cerebral digital subtraction angiography.

Turk Neurosurg 2011 ;21(3):340-6

Istanbul University, Cerrahpasa Faculty of Medicine, Department of Anesthesiology and Reanimation, Istanbul, Turkey.

Aim: Cerebral digital subtraction angiography (DSA) is an invasive procedure and may cause inflammatory responses in the body. This study aims to provide cytokine and lymphocyte profile in a population of patients underwent cerebral DSA.

Material And Methods: Forty-one male patients who admitted for cerebral DSA were included in this study. Patients were divided into two groups: Group I (n = 7) included patients who did not receive analgesia-sedation and group II (n = 34) received analgesia-sedation before procedure. For the molecules, a venous blood samples from every patient was collected before and after cerebral DSA.

Results: Cytokine levels in group I showed a trend to increase in the majority of the molecules after the procedure except IL-1β. In group II, cytokines showed variable trend. When comparing the two groups regarding cytokine levels after cerebral DSA, IL-1β, IL-10, IL-12, and IFN-γ levels increased significantly in group II. Comparing the two groups with respect to lymphocytes after cerebral DSA showed that CD56 levels were significantly higher in group II and other parameters did not show significant differences.

Conclusion: It can be possible that delimitation of the action(s) of the cytokines affecting the secretion or activation of CD56 (natural killer) may avoid complications of inflammation after invasive procedures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5137/1019-5149.JTN.4296-11.1DOI Listing
December 2011

Diffusion-weighted imaging findings in brain death.

Neuroradiology 2012 Jun 27;54(6):547-54. Epub 2011 Jul 27.

Department of Radiology, Division of Neuroradiology, Bakirkoy State Hospital, KMP Istanbul 34300, Turkey.

Introduction: The purpose of the present study was to determine the role of diffusion-weighted imaging (DWI) and to investigate the use of DWI in the diagnosis of brain death (BD).

Methods: We prospectively evaluated 22 patients diagnosed with clinical BD (9 women, 13 men; mean age, 39.63 ± 15.1 years; age range, 9-66 years). All clinical criteria for BD were present in all 22 patients before magnetic resonance imaging, including a positive apnea test. For all cases, DW images, T2-weighted images, and fluid-attenuated inversion recovery were obtained. Thirteen distinct neuroanatomical structures were selected for analysis in all the cases. For each region of interest, the mean, standard deviation, and range of the average apparent diffusion coefficient (ADCav) values were obtained.

Results: For BD patients, ADC values in all neuroanatomical structures were significantly lower than those for control subjects. We determined how ADC values in all structures were related to the diagnostic condition as well as the appropriate threshold ADC values to classify a subject as BD or control. The sensitivity, specificity, positive and negative predictive values, and correct classification rate of ADC cutoff values to distinguish BD from control groups were 100%.

Conclusions: DWI might be used as a noninvasive confirmatory test for the diagnosis of BD in the future.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00234-011-0912-9DOI Listing
June 2012

The effects of valproic acid and levetiracetam on chicken embryos.

J Clin Neurosci 2011 Jun 19;18(6):816-20. Epub 2011 Apr 19.

Department of Anesthesiology, Section of Neuroanesthesiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

For patients with epilepsy, anti-epileptic medication is generally the first line of treatment, but treating pregnant women with epilepsy can be a challenge. Standard anti-epileptic medications have caused developmental abnormalities, so much effort has been put into developing antiepileptic medications with minimal teratogenic effects. In this experimental study, the new-generation anti-epileptic medication levetiracetam and the standard anti-epileptic medication valproic acid were compared in terms of teratogenicity by studying embryonic development in 360 fertile White-Leghorn chicken eggs (conception day 0). We found that levetiracetam may cause severe developmental abnormalities, and is likely not safe for use in pregnant women. As expected, valproic acid caused more frequent developmental abnormalities than levetiracetam, and the risk increased still further when both drugs were administered in combination. Levetiracetam should be used cautiously in pregnant women with epilepsy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jocn.2010.11.005DOI Listing
June 2011

Efficacy of intravenous paracetamol, metamizol and lornoxicam on postoperative pain and morphine consumption after lumbar disc surgery.

Eur J Anaesthesiol 2010 May;27(5):428-32

Department of Anesthesia and Intensive Care, Cerrahpasa Medical Faculty, University of Istanbul, Istanbul, Turkey.

Background And Objective: The combination of opioids with supplemental analgesics is commonly used for additive or synergistic analgesic effects. We aimed to determine the most advantageous supplemental analgesic for postoperative pain relief after lumbar disc surgery.

Methods: This prospective, placebo-controlled, randomized, double-blind study compared the effects of intravenous metamizol, paracetamol and lornoxicam on postoperative pain control, morphine consumption and side effects after lumbar disc surgery. Eighty patients with American Society of Anesthesiologists classification 1 or 2 scheduled for elective lumbar disc surgery under general anaesthesia were treated using patient-controlled analgesia with morphine until 24 h postoperatively and randomized to receive additional intravenous injections of metamizol 1 g, paracetamol 1 g, lornoxicam 8 mg or isotonic saline 0.9% (placebo). The primary endpoint was pain over 24 h after surgery measured by visual analogue scale. Secondary endpoints were morphine consumption and side effects.

Results: During the 24 h study period, pain was reduced in the metamizol (P = 0.001) and paracetamol (P = 0.04) groups, but not in the lornoxicam (P = 0.20) group compared with the control group. Further analysis revealed that pain scores in the metamizol group were significantly lower than in the lornoxicam group (P = 0.031). Although the rate of morphine consumption in the paracetamol group was decreased over time (P < 0.001), the total amounts of morphine consumed in 24 h were not different between groups. No significant differences with respect to morphine-related side effects were observed between groups.

Conclusion: Metamizol or paracetamol, but not lornoxicam, provides effective analgesia following lumbar disc surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/EJA.0b013e32833731a4DOI Listing
May 2010

Acute ethanol intoxication in a model of traumatic brain injury: the protective role of moderate doses demonstrated by immunoreactivity of synaptophysin in hippocampal neurons.

Neurol Res 2004 Jan;26(1):108-12

Department of Anesthesiology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey.

Although ethanol intoxication is reported to be a complicating factor in traumatic brain injury, some recent studies are indicating its possible protective role especially at lower doses. Ethanol inhibition of NMDA-mediated excitotoxicity which predominates at lower doses is believed to be responsible for this protection. The aim of this study was to demonstrate this neuroprotective role of alcohol using immunoreactivity for synaptophysin as an indirect marker for severity of injury. Acute ethanol intoxication at moderate doses was performed 2 h prior to trauma. Severe traumatic brain injury was administrated using an impact acceleration model in Sprague-Dawley rats. At post-traumatic 48th hour, immunorectivity for synapthophysin in the rat hippocampi was evaluated under light microscopy. According to our results there were slight increases in immunoreactivity for synaptophysin in the stratum oriens and striatum radiatum of CA1 subfield of hippocampus when ethanol was administered prior to trauma comparing to moderate increase in the trauma-only group. On the other hand vacuolar degeneration and red neuron formation was more prominent in the pyramidal cell layer of CA1 and CA3 when ethanol was not administered. Ethanol may have a neuroprotective role when administered at moderate doses prior to traumatic brain injury. This effect of ethanol may primarily be due to inhibition of NMDA receptors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1179/016164104773026633DOI Listing
January 2004

Nitric oxide levels in rat cortex, hippocampus, cerebellum, and brainstem after impact acceleration head injury.

Neurol Res 2003 Jan;25(1):31-4

Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

Nitric oxide (NO) is a potential mediator of secondary brain injury in the settings of cerebral ischemia and inflammation. Traumatic brain injury (TBI) alters the levels of stable end products of NO metabolism. We investigated these changes and attempted to identify brain regions that were unique with regard to NO production in the period immediately after TBI. The experiment involved assaying nitrite-nitrate concentrations in the rat cortex, cerebellum, hippocampus, and brainstem after impact-acceleration head injury. Five rats comprised the sham-operated (control) group, five sustained mild head injury (MHI), and five sustained severe head injury (SHI). There was a uniform decline in the tissue concentrations of NO metabolites in all four brain regions in both injured groups. There were no significant differences in the concentrations of NO metabolites among the various sites tested in the MHI group; however, there appeared to be a relationship between degree of decline in NO levels and amount of trauma sustained by a given region in the SHI group. In these rats, NO dropped to the lowest levels in the brain region where the direct trauma was most severe. The results suggest that nitrite-nitrate levels in these four brain regions fall below normal in the first 5 min after impact trauma. This decrease may, in part, be related to reduced activity of all nitric oxide synthase isoforms, which would cause a drop in the levels of NO metabolites. We believe that this decline may be linked to, and may even cause, the global decrease in cerebral blood flow that occurs in the initial stages of TBI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1179/016164103101201085DOI Listing
January 2003