Publications by authors named "Fatih Yakar"

37 Publications

Microsurgical and Tractographic Anatomical Study of Transtemporal-Transchoroidal Fissure Approaches to the Ambient Cistern.

Oper Neurosurg (Hagerstown) 2021 Jan;20(2):189-197

Department of Neurosurgery, Neurosurgery Laboratory, Yeditepe University School of Medicine, Istanbul, Turkey.

Background: Approaching ambient cistern lesions is still a challenge because of deep location and related white matter tracts (WMTs) and neural structures.

Objective: To investigate the white matter anatomy in the course of 3 types of transtemporal-transchoroidal fissure approaches (TTcFA) to ambient cistern by using fiber dissection technique with translumination and magnetic resonance imaging fiber tractography.

Methods: Eight formalin-fixed cerebral hemispheres were dissected on surgical corridor from the temporal cortex to the ambient cistern by using Klingler's method. The trans-middle temporal gyrus, trans-inferior temporal sulcus (TITS), and trans-inferior temporal gyrus (TITG) approaches were evaluated. WMTs that were identified during dissection were then reconstructed on the Human Connectome Project 1021 individual template for validation.

Results: The trans-middle gyrus approach interrupted the U fibers, arcuate fasciculus (AF), the ventral segment of inferior frontoocipital fasciculus (IFOF), the temporal extensions of the anterior commissure (AC) posterior crura, the tapetum (Tp) fibers, and the anterior loop of the optic radiation (OR). The TITS approach interrupted U fibers, inferior longitudinal fasciculus (ILF), IFOF, and OR. The TITG approach interrupted the U fibers, ILF, and OR. The middle longitudinal fasciculus, ILF, and uncinate fasciculus (UF) were not interrupted in the trans-middle gyrus approach and the AF, UF, AC, and Tp fibers were not interrupted in the TITS/gyrus approaches.

Conclusion: Surgical planning of the ambient cistern lesions requires detailed knowledge about WMTs. Fiber dissection and tractography techniques improve the orientation during surgery and may help decrease surgical complications.
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http://dx.doi.org/10.1093/ons/opaa272DOI Listing
January 2021

Experience of Fully Awake Craniotomy for Supratentorial Lesions: A Single Institution Study.

Turk Neurosurg 2020 ;30(6):907-913

Pamukkale University School of Medicine, Department of Neurosurgery, Denizli, Turkey.

Aim: To report and to discuss our experience of awake craniotomy for the treatment of supratentorial lesions.

Material And Methods: We included patients who underwent awake craniotomy for supratentorial tumors between 2007 and 2018. A bipolar stimulation probe was used for patients with eloquent area lesions. The demographic features, presenting symptoms, comorbidities, localization, histopathology, pre- and postoperative Karnofsky performance status, mean operation length, mean length of hospital stay, and intraoperative and postoperative complications were recorded.

Results: We included 250 patients (age, 53.5 ± 15.3 years; range, 15?90 years; 105 females and 145 males) mostly with metastasis (46%). The tumor resection rate was 90 ± 3.6%. Of 30 patients (12%) who experienced an increase in weakness, 26 experienced improvements within three days, and the remainder had permanent symptoms. Intraoperative and postoperative seizures occurred in three (1.2%) and seven (2.8%) patients, respectively, which were controlled by antiepileptic drugs. Dysphasia occurred intraoperatively in seven patients (2.8%) but improved in a month. The mean follow-up duration was 31.8 ± 11.9 months (range, 7?70 months). No mortality was seen during hospitalization.

Conclusion: Awake procedures are a good option in supratentorial lesions to avoid the complications of general anesthesia for patients in poor medical condition. To obtain maximal tumor resection and to maintain better quality of life, neurosurgeons should opt for awake craniotomy when necessary.
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http://dx.doi.org/10.5137/1019-5149.JTN.30747-20.2DOI Listing
April 2021

Subdural Hematoma Evacuation via Rigid Endoscopy System: A Cadaveric Study.

J Craniofac Surg 2020 Sep 8. Epub 2020 Sep 8.

Pamukkale University School of Medicine, Department of Neurosurgery, Denizli.

The utilization of endoscope-assisted surgery is becoming a more common modality for the surgical treatment of subdural collections. Considering the inflexible construction of the rigid endoscope, it's not clear where to perform the optimal craniotomy. Twenty four craniotomies (3 cm diameter) were performed in 8 hemicrania. The craniotomies were placed 1 cm front and behind the coronal suture and to the point where the parietal bone was the most convex. The craniotomies in the anterior (C1) and posterior (C2) of the coronal suture were in the mid pupillary line, while the posterior craniotomy (C3) was just lateral to the midpupillary line. At first, subdural distances measured, and then the distances from the craniotomy to the anterior, posterior, medial, and lateral directions in which endoscope could reach the farthest without the damage to the parenchyma were measured. The subdural distance was significantly deeper in C3 than C1 (P = 0.001); however, there was no difference between C3 and C2 (P = 0.312). The distance that could be reached with C3 was higher than C1 in anterior, posterior, lateral, and medial directions (P ≤0.001, 0.037, <0.001, and <0.001, respectively). The distance that could be reached with C3 was higher than C2 in anterior, posterior, lateral, and medial directions (P < 0.001, 0.02, 0.01 and <0.001, respectively). In subdural hematomas, especially that covers all surface of the hemisphere, the most suitable craniotomy is the posteriorly placed craniotomy to reach the most extended projection in anteroposterior line of the hematoma.
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http://dx.doi.org/10.1097/SCS.0000000000007031DOI Listing
September 2020

Timing of Shunt Insertion in Children with Neural Tube Defects and Hydrocephalus: A Clinical Study.

Turk Neurosurg 2020 ;30(2):194-198

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

Aim: To define the optimal time of shunt insertion in patients with neural tube defects and hydrocephalus.

Material And Methods: In total, 71 patients who underwent operation for neural tube defects and hydrocephalus were retrospectively evaluated between 2012 and 2018. The first group comprised 43 patients who underwent operation at different times (in 10 days after the repair of defect), and the second group comprised 28 patients who underwent operation at the same time. Ruptured and unruptured sacs were immediately considered and operated within 72 hours.

Results: In the first group, 43 patients underwent operation for neural tube defect after birth. Ventriculoperitoneal shunt insertion was performed 10 days after wound healing. Five (11.6%) patients were diagnosed with meningitis on follow-up. Shunt infection or meningitis was not observed on follow-up in the second group, which comprised patients who underwent operation at the same time.

Conclusion: The lowest complication rate existed in hydrocephalus management when shunt insertion and myelomeningocele repair procedures were performed at the same time.
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http://dx.doi.org/10.5137/1019-5149.JTN.26588-19.1DOI Listing
August 2020

Academic performance after neurosurgery residency training in Turkey: a national survey.

Neurosurg Focus 2020 03;48(3):E8

4Department of Neurosurgery, Ankara University School of Medicine, Ibni Sina Hospital, Ankara, Turkey.

Objective: Neurosurgery training programs aim to train specialists. In addition, they are expected to equip the residents with necessary knowledge and skills for academic development. This study aims to gain insights into academic productivity after neurosurgeons graduated from residency training in Turkey.

Methods: An electronic survey was sent to all Turkish Neurosurgical Society members (n = 1662 neurosurgeons) between September and November 2019. The number of participants was 289 (17.4%). Participants were divided into subgroups based on three main factors: training institution type (university hospital [UH] vs training and research hospital [TRH]), training institution annual case volume (low [< 1000 or inadequate cranial/spinal case numbers] vs high [> 1000 and adequate cranial/spinal case numbers]), and training program accreditation status (accredited vs nonaccredited).

Results: The majority of the participants (64.7%) graduated from the UHs. Those trained at UHs (vs TRHs) and high- (vs low-) volume centers had their dissertations more frequently published in Science Citation Index/Science Citation Index-Expanded journals, gave more oral presentations after residency, had higher h-indices, had higher rates of reviewership for academic journals, and had greater participation in projects with grant support. In addition, graduates of accredited programs reported more PhD degrees than those of nonaccredited programs.

Conclusions: Neurosurgeons trained in higher-case-volume, accredited programs, mostly in the UHs, performed better in terms of scientific activities and productivity in Turkey. Strong research emphasis and supportive measures should be instituted to increase academic performance during and after residency training.
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http://dx.doi.org/10.3171/2019.12.FOCUS19825DOI Listing
March 2020

Supraorbital Keyhole Approach: Lessons Learned from 106 Operative Cases.

World Neurosurg 2019 Jan 17. Epub 2019 Jan 17.

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

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

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

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

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

Endoscopic Endonasal Approaches to Craniovertebral Junction Pathologies: A Single-Center Experience.

Turk Neurosurg 2018 Aug 27. Epub 2018 Aug 27.

Ankara University School of Medicine, Ibni Sina Hospital.

Aim: The craniovertebral junction is a remarkable anatomical area with unique anatomical and functional relationships, which present difficult challenges for surgeons. The traditional approach to addressing pathologies in this area is microscopic transoral resection with posterior fixation; however, endoscopic endonasal clivus and odontoid surgeries now currently gaining interest as alternative approaches. We reviewed our experience of using the endoscopic endonasal approach at our institution.

Material And Methods: We retrospectively evaluated 41 patients (21 male, 20 female; age range, 2-65 years) who underwent endoscopic endonasal procedures for craniovertebral junction pathologies between 2008 and 2017.

Results: Of the 41 patients, 27 had clivus lesions, 7 had odontoid lesions, 6 had basilar invagination and 1 had rhinorrhea repair. Six patients underwent an additional posterior decompression/fusion either before or after the endonasal procedure. None of the patients required tracheostomy and cerebrospinal fluid leakage was detected in one patient postoperatively. The patients' mean modified Rankin scale and visual analog scale scores were 3 and 4 respectively. The follow-up period ranged from 12 to 50 months.

Conclusion: Although the microscopic transoral approach has been considered the gold standard for craniovertebral junction surgical management, endoscopic approaches are feasible, safe, and effective for addressing pathologies in this region, with developing technique and experience.
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http://dx.doi.org/10.5137/1019-5149.JTN.23781-18.2DOI Listing
August 2018

Relationship between individual payload weight and spondylolysis incidence in Turkish land forces.

Neurosurg Focus 2018 12;45(6):E12

4Department of Neurosurgery, University of Health Sciences, Gulhane Education and Research Hospital, Ankara, Turkey.

OBJECTIVEThe aim of this study was to investigate the relationship between lumbar spondylolysis and payload weight between different combat units of Turkish land forces (TLF).METHODThe authors reviewed clinical and radiological data of the military personnel with low-back pain (LBP) admitted to their clinic between July 2017 and July 2018. Age, BMI, average payload weight, and military service unit were recorded. CT scans were evaluated for pars interarticularis fractures and spondylolisthesis, whereas MRI studies were evaluated for spondylolisthesis, Modic-type endplate changes, or signal loss on T2-weighted images compatible with disc degeneration.RESULTFollowing exclusion, a total of 642 all-male military personnel were included. Of these personnel, 122 were commandos, 435 were infantry, and 85 were serving in the artillery units. Bilateral pars interarticularis fracture was noted in 42 commandos (34.42%) and 2 infantrymen (0.45%). There was no spondylolysis in the artillery units. There was no multiple-level spondylolysis and the most common level of spondylolysis was L5. Commandos had a significantly higher incidence of spondylolysis and more average payload weight (p < 0.001). Twelve patients (27.2%) with spondylolysis had accompanying MRI pathologies at the same level, whereas 32 patients (72.7%) had no accompanying MRI pathologies.CONCLUSIONSIncreased payload weight in military personnel is associated with spondylolysis, and commandos in the TLF have significantly heavier payloads, which causes an increased rate of spondylolysis compared to other units. Additionally, spondylolysis without adjacent-level changes on MRI could be undiagnosed. LBP in active military personnel who have a history of carrying heavy payloads should be evaluated extensively with both MRI and CT scans.
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http://dx.doi.org/10.3171/2018.8.FOCUS18375DOI Listing
December 2018

Sellar Embryonal Tumor: A Case Report and Review of the Literature.

Asian J Neurosurg 2018 Oct-Dec;13(4):1197-1201

Department of Neurosurgery, Ankara University, Ankara, Turkey.

Primitive neuroectodermal tumors (PNETs) are aggressive, poorly differentiated tumors in children and young adults. However, the embryonal tumor group did not include the central nervous system (CNS) PNET title and ependymoblastoma subtitle in the 2016 World Health Organization CNS tumor classification. Here, we report the case of a 6-year-old boy with a sellar embryonal tumor and present a review of the related literature. To the best of our knowledge, this is the first case of an endoscopically operated sellar embryonal tumor in the pediatric age group.
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http://dx.doi.org/10.4103/ajns.AJNS_30_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6208192PMC
November 2018

Osteogenesis Imperfecta and Extra-/Intradural Hematomas: A Case Report and Review of the Literature.

J Pediatr Genet 2018 Dec 14;7(4):185-190. Epub 2018 Jun 14.

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

Osteogenesis imperfecta, also named as brittle bone disease, is characterized by fragile bones and short stature caused by mutations in the collagen gene. Subdural and intraparenchymal hematomas are defined and associated with trauma, vascular causes, and systemic bleeding diathesis. Skull fragility may lead to epidural hematoma, which is a life-threatening situation. Vascular fragility and intrinsic platelet defects are the causes of bleeding in patients with osteogenesis imperfecta, which is a major management challenge for neurosurgeons. Here, we reported on a 5-year-old boy with osteogenesis imperfecta with epidural hematoma and skull fracture following a trivial trauma, and made a literature review of 28 cases with extra-/intradural hematoma.
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http://dx.doi.org/10.1055/s-0038-1660826DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234040PMC
December 2018

Structure of corona radiata and tapetum fibers in ventricular surgery.

J Clin Neurosci 2018 Nov 27;57:143-148. Epub 2018 Aug 27.

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

In this study the three-dimensional anatomy of the corona radiata and tapetum via the fiber dissection and diffusion tensor imaging of the brain for ventricular surgery was demonstrated. Ten formalin-fixed cerebral hemispheres were dissected for corona radiata and tapetum via Klingler's fiber dissection method under an operating microscope. The corona radiata and tapetum were dissected through lateral and medial surfaces of the cerebral hemisphere, respectively. All surgical routes for ventricular lesions were evaluated for white matter fibers during and after dissections. Corona radiata and tapetum fibers were demonstrated by dissecting hemispheres through lateral and medial aspects of the brain. The internal capsule contains all fibers that extend from thalamus to cortex and cortex to thalamus, brainstem, and spinal cord. These fan-shaped fibers extending from cortex to internal capsule were named the corona radiata. The corona radiata is not a specific pathway, and it is composed of several different fiber pathways. The tapetum contains splenium and body fibers of the corpus callosum. Tapetum is located immediately medial to the ependymal line of the ventricular wall and forms a fiber layer in the medial optical radiation on the coronal and axial sections. Surgical planning for ventricular lesions requires detailed information regarding white matter fibers that can be obtained by the fiber dissection and diffusion tensor imaging of the brain to decrease surgical complications.
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http://dx.doi.org/10.1016/j.jocn.2018.08.041DOI Listing
November 2018

Is a Unilateral Surgical Approach Effective in Patients with Bilateral Leg Pain with Unilateral Lumbar Disc Herniation? A Prospective Nonrandomized Clinical and Surgical Study.

World Neurosurg 2018 Sep 12;117:e316-e322. Epub 2018 Jun 12.

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

Objective: To examine the surgical results of unilateral lumbar discectomy in patients with bilateral leg pain and discuss short- and long-term outcomes within the limits of lumbar decompression.

Methods: We analyzed 60 patients with unilateral disc herniation who underwent unilateral lumbar discectomy and hemipartial laminectomy between 2014 and 2017. Group 1 (30 patients) had bilateral leg pain and unilateral lumbar disc herniation. Pain lateralization was determined radiologically. Group 2 (30 patients) had unilateral leg pain and unilateral lumbar disc herniation. Pain scores were preoperatively evaluated with visual analog scale (VAS) for both legs and Oswestry Disability Index (ODI) for overall life quality. In both groups, surgery was performed on the ipsilateral side of the herniated disc. Scores were repeated on postoperative day 1 and 1, 3, 6, 12, and 24 months later. VAS score differences for pain lateralization and disc levels were compared in group 1. ODI score differences were compared between both groups. Results were statistically analyzed.

Results: VAS score differences were statistically significant at all follow-up time points in patients with ipsilateral and contralateral pain. VAS score differences between L4-L5 and L5-S1 level discopathies were statistically insignificant for all time points in both groups. All postoperative ODI score decreases for all time points were statistically significant (P < 0.001) for both groups, whereas the differences between groups 1 and 2 were statistically insignificant.

Conclusions: Conventional lumbar disc surgery alone is sufficient for the ipsilateral side of radiologically demonstrated disc herniation in patients with bilateral leg pain.
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http://dx.doi.org/10.1016/j.wneu.2018.06.022DOI Listing
September 2018

Median nerve schwannoma.

ANZ J Surg 2019 09 24;89(9):1158-1159. Epub 2018 Apr 24.

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

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http://dx.doi.org/10.1111/ans.14471DOI Listing
September 2019

Surgical Management of Supratentorial Intracerebral Hemorrhages: Endoscopic Versus Open Surgery.

World Neurosurg 2018 Jun 19;114:e60-e65. Epub 2018 Mar 19.

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

Objective: Intracerebral hemorrhage continues to be a major global problem. No standard treatment or surgical procedure has been identified for intracerebral hemorrhages. High morbidity and mortality rates caused by conventional approaches and the disease itself have necessitated more-invasive treatment methods. The endoscopic approach is a more minimally invasive method than craniotomy, which is another alternative surgical treatment.

Methods: We compared intracerebral hematoma drainage in 2 groups of 17 patients each, treated with minimally invasive endoscopic method versus craniotomy. All the patients were treated for supratentorial spontaneous hemorrhage between December 2013 and February 2017 at the Neurosurgery Clinic of Ankara University Faculty of Medicine.

Results: We retrospectively evaluated 34 patients surgically treated between December 2013 and February 2017. All patients underwent surgery within the first 24 hours. Patients in the early surgery group had better surgical outcomes. In the neuroendoscopic group, Glasgow Coma Scale increased from 6 to 11 at 1 week postoperatively compared with 5 to 9 in the craniotomy group.

Conclusions: Minimally invasive endoscopic hematoma evacuation may be a good alternative surgical method for treating supratentorial spontaneous cerebral hematomas.
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http://dx.doi.org/10.1016/j.wneu.2018.02.056DOI Listing
June 2018

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

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

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

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

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

Subcutaneous Schwannoma in the Head Region.

Asian J Neurosurg 2018 Jan-Mar;13(1):96-97

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

Schwannoma is a benign neural tumor derived from Schwann cells surrounding the nerves. It occurs primarily in subcutaneous tissues and muscles with a tendency for distal extremities, head, and neck area. Treatment of schwannoma is surgical excision. Lipomas are the most common soft-tissue lesions. A case is presented to increase awareness on differential diagnosis of head and neck subcutaneous masses.
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http://dx.doi.org/10.4103/1793-5482.185064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5820908PMC
March 2018

Endoscopic carpal tunnel decompression: Comparison of mid- and long-term outcomes of 30 endoscopic and 30 standard procedure carpal tunnel decompression operations.

Asian J Neurosurg 2017 Jul-Sep;12(3):534-536

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

Background: Carpal tunnel syndrome is the most frequently seen trap neuropathy leads to pain, paresis, and weakness of hands.

Methods: Totally, 60 patients who underwent endoscopic or standard CTS surgery in İbni Sina Hospital, Medical Faculty of Ankara university in the period of 2009 and 2012 were enrolled in this prospective study.

Results: During 36 months, 60 patients had undergone hand surgery. Totally, 14 male and 46 female patients of this serial had an average age of 51.24 (22-74) years. A number of 26 patients (43%) had left and 34 had (57%) right hand surgery. Complete relief of nocturnal paresis and pain has been shown in the 6, 12, and 24 month analyses of endoscopic surgery group results. Two patients in open surgery group underwent second operation due to relapse. The patients in the endoscopic group reported higher satisfaction cosmetically.

Conclusion: Endoscopic carpal tunnel syndrome treatment is alternative and considerable option against standard open methods and due to low morbidity rates its performance is highly prevalent in recent years.
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http://dx.doi.org/10.4103/1793-5482.210002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5532944PMC
August 2017

Prognostic importance of central thrombus in hemodynamically stable patients with pulmonary embolism.

Cardiol J 2017 1;24(5):508-514. Epub 2017 Mar 1.

Ankara Atatürk Training and Research Hospital, Department of Pulmonary Medicine, Ankara, Turkey.

Background: The association between mortality and localization of central thrombus in hemodynamically stable patients with pulmonary embolism (PE) is unclear. Sufficient data are not available to help clinicians to select between low molecular weight heparin (LMWH), unfractionated heparin (UFH) and thrombolytics for the management of central thrombus. The present study aims to investigate whether central thrombus in the pulmonary artery affects 30-day mortality rate, and to compare the outcomes of different treatment approaches in patients with central thrombus.

Methods: This multi-central, prospective, observational study included 874 hemodynamically stable patients with PE confirmed by multidetector computed tomography scan. The localization of the emboli was evaluated and categorized as central (saddle or at least one main pulmonary artery), lobar or distal. The primary study outcome was 30-day all-cause mortality.

Results: Localization of the emboli was central in 319 (36.5%) patients, lobar in 264 (30.2%) and distal in 291 (33.2%) patients. Seventy-four (8.5%) patients died during the 30-day follow-up period. All-cause mortality rate was 11.9%, 6.8% and 6.2% in patients with central, lobar, and distal emboli, respectively (p < 0.001). Multivariate analysis did not show that hemodynamically stable central thrombus was an independent predictor of mortality. Additionally, mortality rate was not significantly different between UFH, LMWH and thrombolytic therapy groups.

Conclusions: The present study showed that central thrombus was not an independent predictor of mortality in hemodynamically stable PE patients. LMWH and UFH were similarly effective in the treatment of this patient group.
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http://dx.doi.org/10.5603/CJ.a2017.0021DOI Listing
June 2018

Does CPAP treatment lead to gastroesophageal reflux in patients with moderate and severe OSA?

Eur Arch Otorhinolaryngol 2017 Mar 22;274(3):1223-1229. Epub 2016 Jun 22.

Department of Chest Diseases, Bezmialem Vakıf University, Istanbul, Turkey.

Obstructive sleep apnea (OSA) leads to upper respiratory tract obstruction, causing increased abdominal-gastric pressure and decreased lower esophageal sphincter (LES) pressure and thus gastroesophageal reflux (GER). Continuous positive airway pressure (CPAP) is known to be an effective method for OSA treatment, but its effect on GER is still controversial. There are a very few studies investigating CPAP and GER relationship and performed based on pre- and post-treatment objective parameters of GER in patients with OSA. The study investigated the effect of CPAP treatment in patients with moderate and severe OSA without GER complaints on pre- and post-treatment objective GER parameters. The study included 25 patients with respiratory disturbance indices >15 without reflux symptoms who had undergone polysomnography at sleep laboratory. Age, sex, body mass index (BMI), waist, and neck circumference of the patients were documented. DeMeester score, LES pressure, and polysomnography parameters were evaluated pre- and post-CPAP. The results were statistically evaluated, and p value <0.05 is considered significant. Out of 25 patients, 21 were male (84 %) and mean age was 49.2 ± 8.6 (range 31-66). At the pre-CPAP phase, mean sphincter pressure was 22.2 ± 1.2 (range 8-73), and mean DeMeester score was 18 ± 15.5 (range 0.2-57). At the post-CPAP, mean sphincter pressure was 22.9 ± 1.6 (range 9-95), and mean DeMeester score was 16.3 ± 14.8 (range 0.2-55). No significant difference (p > 0.05) was found comparing pre-CPAP and post-CPAP measurements. Objective criteria show that CPAP treatment does not cause reflux in patients with OSA. Unlike studies reported in the literature, this conclusion has been reached by pre- and post-CPAP assessments.
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http://dx.doi.org/10.1007/s00405-016-4116-0DOI Listing
March 2017

Cardiac Findings of Pulmonary Thromboembolism by Autopsy: A Review of 48 Cases.

Med Sci Monit 2016 Apr 27;22:1410-4. Epub 2016 Apr 27.

Council of Forensic Medicine, Ministry of Justice, Istanbul, Turkey.

BACKGROUND To identify the overall effects of pulmonary thromboembolism (PTE) on the heart, we evaluated the heart findings and clinical characteristics of deceased patients diagnosed with PTE. MATERIAL AND METHODS PTEs were classified into 2 categories: fatal and contributory. Cases with a history of cardiopulmonary disease or a finding of significant disease at autopsy, including valvular heart disease and coronary artery obstruction >50%, were excluded from the cardiac evaluation. We defined an LV wall ≥1.2 cm thick and an RV wall ≥0.8 cm thick as abnormal. RESULTS Forty-eight cases were included to the study (21 males and 27 females). The mean age was 41.42 ± 16.5 years. Of the 48 cases, 5 were excluded due to cardiopulmonary diseases for determining heart findings. The thicknesses of the LV and RV walls were not measured in some patients. In the 43 cases, cardiac hypertrophy was detected in 28 patients (65.1%). The mean heart weight was 387 ± 83.5 g. The mean thickness of the left ventricle (LV) wall was 1.40 ± 0.41 cm in 40 cases, and the mean thickness of the RV wall was 0.41 ± 0.135 cm in 41 cases. The LV walls of 35 (87.5%) cases and the RV walls of 2 cases met criteria for abnormal wall thickness. There were histopathological findings of heart in 24/43 cases (56%); these findings were necrosis, fibrosis, and hypertrophy. CONCLUSIONS The RV is affected by massive pulmonary embolism; however, the LV may also play a role in the pathogenesis of PTE.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4913817PMC
http://dx.doi.org/10.12659/msm.897695DOI Listing
April 2016

Does Every Necrotizing Granulomatous Inflammation Identified by NSCLC Resection Material Require Treatment?

Med Sci Monit 2016 Apr 11;22:1218-22. Epub 2016 Apr 11.

Department of Pulmonary Medicine, Istanbul University, Medical Faculty, Istanbul, Turkey.

BACKGROUND Lung cancer and tuberculosis (TB) are two major public health problems. They can coexist or appear sequentially. In patients with TB, lung cancer risk is increased. However, vice versa is not crystal clear. In this study, we aimed to determine the development of TB in patients with resectabled non-small cell lung cancer (NSCLC) in a 2-year postoperative follow-up period. MATERIAL AND METHODS We conducted a retrospective cohort study at three university hospitals. Patients who had NSCLC surgery between 2009 and 2013 were included and patient records were reviewed for the presence of necrotizing granulomatous inflammation (NGI) in resected specimens. Demographic properties, tumor type, stage, location, type of surgery, tuberculosis history, and thorax CT findings were recorded. We searched for the development of tuberculosis within a 2-year period after surgery. RESULTS A total of 1027 patient cases were reviewed, of which 48 patients had NGI. The median age was 63 years. The most common type of cancer was squamous carcinoma; and lobectomy was the preferred operation (70.8%). Cancer involvement most commonly included the right lung (61.8%) and upper lobes (47,9%). Only 11 patients had anti-TB treatment postoperatively, which was based on radiological findings. Prior tuberculosis or anti-TB history, type, stage or localization of cancer, and adjuvant/neoadjuvant therapy were not found to be related to TB treatment. None of the study population had TB during the two-year follow-up period. Treatment decisions appeared mostly related to physician experience. There was no difference in the risk of developing TB between patients with or without treatment. This finding may change the management of our patients. CONCLUSIONS Every NGI discovered in NSCLC resected material does not always require anti-TB treatment.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4830200PMC
http://dx.doi.org/10.12659/msm.897638DOI Listing
April 2016

Pneumorrhachis.

Asian J Neurosurg 2016 Apr-Jun;11(2):172-3

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

The presence of air in spinal canal is called as "pneumorrhachis." Nontraumatic, noniatrogenic spontaneous spinal air is an uncommon case. Peripheral alveoli burst due to the increased pressure in alveoli in the case of trauma, asthma, pneumothorax, or pneumomediastinum. Air pass to the mediastinum and then to retropharyngeal space and reaches to epidural space. In this paper, a 44-year-old female patient who has a spontaneous pneumorrhachis in the epidural space in the spinal canal L5-S1 lumbar level has been presented.
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http://dx.doi.org/10.4103/1793-5482.175641DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4802945PMC
April 2016

Relationship of CTLA4 and CD28 polymorphisms with lung involvement, HRCT findings and pulmonary function tests in Turkish patients with ankylosing spondylitis.

Clin Respir J 2017 Sep 9;11(5):593-601. Epub 2015 Oct 9.

Department of Chest Disease, Bezmialem Vakif University, Istanbul, Turkey.

Background And Aims: Ankylosing spondylitis (AS) is a multisystem disorder with ocular, pulmonary, and cardiovascular involvement. The incidence of pulmonary involvement varies from 1 to 52%. Abnormal T-cell function-derived immune responses are involved in AS pathogenesis. Numerous genes such as CTLA4 and CD28 control T-cell functions. In this study, we aimed to address the relationship between CTLA4 and CD28 polymorphisms and lung involvement in Turkish patients with AS.

Methods: A cross-sectional evaluation of 80 healthy and 89 AS subjects with no active infection or malignancy was performed to determine the relationship between pulmonary involvement and CTLA4 and CD28 gene polymorphisms. All patients were assessed for clinical, radiological, and spirometric findings. Descriptive statistics, chi-square tests, and independent-sample t-tests were used for statistical analyses.

Results: All patients with the CD28 CC genotype (n = 4) had abnormal HRCT, but it was not significant (p = 0.47). All of the normal HRCT patients have CD 28 T alleles. In addition to this data ; 4 patients who have not any T alleles have abnormal HRCT finding. It was significant and was considered that T genotype have protective effect (p= 0,047) on radiologic involvement but no other association was found between CTLA4 and CD28 gene polymorphism with respect to pulmonary function tests (PFT), diffusion capacity, and clinical characteristics in the Turkish patients with AS.

Conclusion: Our results suggest a possible association of CTLA4 and CD28 variants with AS pulmonary involvement. Furthermore, these results may lead to the development of new therapeutic agents to control more aggressive forms of the disease. However, further studies are needed in larger populations.
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http://dx.doi.org/10.1111/crj.12388DOI Listing
September 2017

Role of daytime polysomnography in the diagnosis of sleep apnea syndrome.

Tuberk Toraks 2015 Jun;63(2):78-85

Department of Chest Diseases, Faculty of Medicine, Bezmiâlem Vakif University, Istanbul, Turkey.

Introduction: Diagnosis of sleep apnea syndrome (SAS) depends on nocturnal polysomnography (nPSG), but waiting time for the test is long. Although, performing PSG in patients with excessive daytime sleepiness (EDS) at daytime (dPSG) was questioned, role and methods are not clear. The aim of the study was to assess the role of dPSG in the diagnosis of SAS, and the correlation between nPSG and dPSG.

Patients And Methods: Forty eight subjects, who were referred to our sleep laboratory with EDS were included to a cross-over study. Half of the patients underwent nPSG after dPSG, vice versa. Seven subjects excluded due to lack of participation. The rest (n= 41) had nPSG and dPSG. PSG recordings and analysis were performed according to AASM 2007 guideline. Results were analyzed for sleep efficiency, respiratory disturbance index (RDI), oxygen desaturation index (ODI), SAS severity and correlation between dPSG and nPSG.

Results: Total 41 subjects were analyzed. All patients had diagnosis of SAS. Sleep efficiency was higher at nPSG (86%), however also enough at dPSG (80%). Sleep stages of dPSG and nPSG were similar except stage 3 sleep, which was longer at nPSG. Undergoing dPSG or nPSG first did not correlate with sleep efficiency, respiratory disturbance (RDI) index, oxygen desaturation index (ODI) or severity of SAS. Despite BMI, neck circumference was closely related with RDI, ODI and severity.

Conclusion: Daytime PSG, when performed appropriately, is an effective tool for diagnosing sleep disorders in patients with EDS. dPSG may decrease the amount of times that patients must wait to undergo PSG.
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http://dx.doi.org/10.5578/tt.8538DOI Listing
June 2015

Use of PET-CT for the assessment of treatment results in patients with sarcoidosis.

Wien Klin Wochenschr 2015 Apr 2;127(7-8):274-82. Epub 2014 Dec 2.

Forensic Science Institution, Ministry of Justice, Istanbul, Turkey.

Background And Aim: Sarcoidosis is a multisystem disease of unknown origin. Determining the involvement and the response to the treatment is important. The aim of this study was to identify the effects of methylprednisolone and indomethacine on metabolic activity and pulmonary function test parameters in patients with sarcoidosis.

Material And Methods: A total of 24 pulmonary sarcoidosis patients were enrolled in the study. All the patients underwent spirometry and [(18)F]fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) scan before treatment and were divided into two groups according to the necessity of corticosteroid treatment or not. Patients who did not have corticosteroid indication were treated with indomethacine. Symptomatic patients and patients who did not respond to indomethacine treatment received methylprednisolone. Patients were followed up on a monthly basis to determine the response. FDG uptakes as the disease activity were re-evaluated before ending the treatment at the sixth month.

Results: Mean age of patients (16 male, 8 female) was 39.79 (9.3) years. Besides mediastinum and pulmonary parenchyma, extrapulmonary sites were also involved in patients with pulmonary sarcoidosis (distant lymph nodes (upper abdominal, supraclavicular, inguinal, and axillary), liver, and spleen). Although maximum standard uptake values of methylprednisolone group regressed significantly (p < 0.001) after treatment, indomethacine group did not have significant regression (p = 0.345). Despite metabolic regressions, spirometry values of patients did not significantly increase (p > 0.005).

Conclusion: FDG PET-CT may be useful for determining activity and the efficacy of treatments. Methylprednisolone is effective in reducing metabolic activity but does not lead to improvement in functional parameters.
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http://dx.doi.org/10.1007/s00508-014-0647-9DOI Listing
April 2015

COPD: an underdiagnosed disease at hospital environment.

Wien Klin Wochenschr 2014 Feb 19;126(3-4):73-8. Epub 2013 Nov 19.

Department of Pulmonary Medicine, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey.

Background And Aim: Chronic obstructive pulmonary disease (COPD) is a serious disease with morbidity and mortality due to delayed diagnosis until significant symptoms arise. We aimed to assess the utility of spirometry and COPD Assessment Test (CAT) in detecting undiagnosed COPD patients in a localized area.

Material And Methods: People who came to the hospital for patient visit or examination with a smoking history of > 10 pack-years (> 40 years old), and with no known chest disease were invited to study. The participants completed a questionnaire and performed spirometry. Spirometry was performed according to ATS/ERS Task Force on spirometry. COPD was defined as according to the Global Initiative for Chronic Obstructive Lung Disease guidelines.

Results: There were 800 subjects screened, and 648, capable of performing spirometry, were included to the study. The mean age was 48.3 ± 9.0 and 38 % of the study population was male. Post-bronchodilator FEV1/FVC ratio was lower than 0.70 in 17 % of the subjects. Median (25-75 percentiles) total CAT scores and among the questions of CAT; cough, phlegm, chest tightness and breathlessness scores for COPD and non-COPD subjects were; 15(9-22) vs 12(6-18) (p  = .004), 2(1-3) vs 1(0-2) (p  < .001), 2(0-3) vs 1(0-3) (p  = .004), 3(1-4) vs 2(0-3) (p  > .001), 4(3-5) vs 3(2-4) (p  = .001), respectively. Symptom prevalence was as follows: exertional dyspnea 91 %, dyspnea 80.9 %, cough 56.3 % and phlegm 58.3 % in COPD.

Conclusion: Our study showed that spirometric screening together with the CAT questionnaire may improve the awareness of disease and may determine undiagnosed patients.
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http://dx.doi.org/10.1007/s00508-013-0458-4DOI Listing
February 2014

Does hormonal control obviate positive airway pressure therapy in acromegaly with sleep-disordered breathing?

Respir Med 2013 Nov 11;107(11):1803-9. Epub 2013 Sep 11.

Department of Pulmonology, Bezmialem Vakif University Medical School, Istanbul, Turkey. Electronic address:

Introduction: Acromegaly is a disease in which uncontrolled release of growth hormone occurs after closure of epiphyseal plates, causing changes in the body that can lead to sleep disordered breathing (SDB). No definite guidelines regarding the treatment of SDB in acromegaly are available. In this study, we aimed to investigate the prevalence of SDB in acromegaly and whether hormonal control alters the necessity of positive airway pressure (PAP) therapy in acromegaly patients with SDB.

Methods: Forty-two acromegaly patients were included in the study and divided into two groups according to disease status, i.e., active or well controlled. All patients underwent polysomnography. Fourteen patients with active acromegaly were diagnosed with SDB and were evaluated for PAP therapy with polysomnography both before and 6 months after disease control was achieved.

Results: Sleep-disorder breathing was diagnosed in 22 of 42 patients, 7 of 20 patients with controlled-disease and 15 of 20 patients with active diseases. There were significant reductions in respiratory disturbance index (RDI), apnea index, desaturation index, central apnea number, and rapid eye movement-phase RDI at the control polysomnography. Initially, PAP therapy was indicated in 12 of 14 patients and PAP therapy indication held in 11 patients after acromegaly control was achieved.

Conclusion: Our study revealed that over half of patients with acromegaly had SDB. Furthermore, SDB severity decreases with acromegaly treatment; however, this decrease does not change the indication for PAP therapy; therefore, PAP therapy should not be delayed in acromegalic SDB patients.
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http://dx.doi.org/10.1016/j.rmed.2013.08.043DOI Listing
November 2013

Isoniazid- and rifampicin-induced thrombocytopenia.

Multidiscip Respir Med 2013 Feb 13;8(1):13. Epub 2013 Feb 13.

Department of Pulmonary Medicine, Bezmialem Vakif University, 34093, Fatih, Istanbul, Turkey.

Treatment of tuberculosis has many side effects. Thrombocytopenia is a serious side effect of such treatment and occurs mostly due to rifampicin (RIF). There are very few reported cases of thrombocytopenia due to isoniazid (INH). An 18-year-old female patient was diagnosed with smear-positive pulmonary tuberculosis. A four-drug regimen [INH, RIF, ethambutol (EMB), and pyrazinamide (PZA)] was given. After the development of thrombocytopenia, the drug treatment was stopped, and a thrombocyte suspension was given until a normal thrombocyte count was obtained. After several start-stop trials, first INH and then RIF were identified as the possible causes of thrombocytopenia and were removed from the regimen. The patient was treated with EMB, streptomycin, PZA, and moxifloxacin with no further development of thrombocytopenia. The current case shows that antituberculosis drugs other than RIF and PZA may be responsible for the development of thrombocytopenia.
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http://dx.doi.org/10.1186/2049-6958-8-13DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3660205PMC
February 2013

Evaluation of glutathione S-transferase P1 polymorphisms (Ile105Val and Ala114Val) in patients with small cell lung cancer.

Genet Test Mol Biomarkers 2012 Jul 17;16(7):701-6. Epub 2012 Feb 17.

Department of Genetics, Institute for Experimental Medicine (DETAE), Istanbul University, Istanbul, Turkey.

Aims: Glutathione S-transferase P1 (GSTP1) plays an important role in cellular protection against oxidative stress and toxic chemicals. Polymorphisms within GSTP1 are associated with alterations in enzyme activity, which may lead to development of lung disease and cancer. In this study, we aimed to investigate the GSTP1 Ile105Val and Ala114Val polymorphisms in patients with small cell lung cancer (SCLC).

Patients/methods: GSTP1 Ile105Val polymorphism in exon 5 and GSTP1 Ala114Val polymorphism in exon 6 were determined by using polymerase chain reaction-restriction fragment length polymorphism techniques in 89 patients with SCLC and 108 control patients with chronic obstructive pulmonary disease (COPD). Genotype frequencies and cigarette smoking intensities were compared among SCLC and COPD patients.

Results: There were significantly less SCLC patients with variant exon 6 genotypes than COPD patients (7.9% vs. 20.4%, p=0.007), while the number of patients with variant exon 5 genotypes were comparable among groups. SCLC and COPD patients with variant exon 6 genotype showed trends toward exhibiting reduced cigarette consumption.

Conclusions: The variant GSTP1 exon 6 genotype might be conferring protection against SCLC development. Whether this effect is associated with exposure to cigarette smoking needs to be clarified.
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http://dx.doi.org/10.1089/gtmb.2011.0315DOI Listing
July 2012

Effect of proton pump inhibitor (PPI) treatment in obstructive sleep apnea syndrome: an esophageal impedance-pHmetry study.

Hepatogastroenterology 2011 Sep-Oct;58(110-111):1566-73. Epub 2011 Jul 15.

Department of Gastroenterology, Istanbul University, Istanbul, Turkey.

Background/aims: There is an increasing interest for a link between gastroesophageal reflux (GER) and obstructive sleep apnea syndrome (OSAS). There is no study in the literature which examines the relationship between OSAS and esophageal functions in adults with impedance. We first evaluated the role of reflux in OSAS with simultaneous polysomnography and impedance-pHmetry and then investigated whether the effect of proton pump inhibitor (PPI) treatment changes in these parameters.

Methodology: Twenty two OSAS patients who had applied to sleep laboratory between September 2007 and May 2008 were consecutively enrolled to the study. Twenty four hours esophageal impedance study was performed during polysomnographic recording. At least 50% of all apneas in patients must proceed with a reflux event in 2 minute intervals in order to be considered reflux related apnea patient.

Results: Pathologic reflux episodes were determined in 20 patients (8 were weakly acidic, 12 were acidic). Reflux dependent apnea was found in 6 patients. There was endoscopically esophagitis in all reflux related apnea patients. There was a negative correlation between initial mean SaO2 and gas reflux events at night (p=0.004, r =-0.588) and mixed reflux events at night (p=0.02, r=0.493). There was a statistically significant regression of AHI (apnea hypopnea index) after 3-months PPI treatment (p=0.012).

Conclusions: Reflux may trigger apnea in some of the OSAS patients. Therefore, each OSAS patient must be inquired about esophageal and extraesophageal symptoms of reflux.
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http://dx.doi.org/10.5754/hge10465DOI Listing
January 2012