Publications by authors named "Gokmen Kahilogullari"

71 Publications

Temporal Artery and Temporal Region Supplied by the Middle Cerebral Artery: An Anatomical Study.

J Craniofac Surg 2021 Mar 5. Epub 2021 Mar 5.

Department of Neurosurgery, Karabuk University, School of Medicine, Karabuk Department of Neurosurgery, Yuksek Ihtisas University, School of Medicine Department of Anatomy Department of Neurosurgery Department of Biostatistics, Ankara University, School of Medicine, Ankara, Turkey.

Abstract: This study was conducted to describe in detail the branching patterns of cortical branches from the middle cerebral artery supplying the feeding of the temporal region, to define the arterial structure of temporal artery (TA) and to determine the effect of this arterial supply to the temporal region. The arteries of brains (n = 22; 44 hemispheres) were prepared for dissection after filling them with colored latex. TA was defined, and its classification was described, specifying its relationship with other cortical branches. A new classification was defined related to TA terminology. TA was found in 95% of cadavers, and it originated as an early branch in 75% and from the inferior trunk in 24% of cadavers. TA was classified as Type 0: No TA, Type I: single branch providing two cortical branches, Type II: single branch providing three or more cortical branches and Type III: double TA. Type I-TA (45%) was the most common, and Type II-TA arterial diameter was significantly larger than that of other types. All cadavers showed the cortical branches of temporal region from middle cerebral artery, anterior TA , middle TA, posterior TA and temporooccipital artery, except temporopolar artery (81%). Temporopolar artery, anterior TA, and middle TA primarily originated from TA, an early branch, but posterior TA and temporooccipital artery primarily originated from the inferior trunk. Detailed knowledge about cortical branches together with TA and also this region's blood supply would enable increased prediction of complications, especially in cases with these region-related pathologies, and would make interventions safer.
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http://dx.doi.org/10.1097/SCS.0000000000007612DOI Listing
March 2021

Endoscopic Transnasal Skull Base Surgery in Pediatric Patients.

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

Department of Neurosurgery, Ankara University, Ankara, Turkey.

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

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

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

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

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

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

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

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

Endoscopic Anatomy and a Safe Surgical Corridor to the Anterior Skull Base.

World Neurosurg 2021 01 25;145:e83-e89. Epub 2020 Sep 25.

Department of Neurosurgery, Ankara University, School of Medicine, Sihhiye, Ankara, Turkey. Electronic address:

Objective: We describe the possibility to create precise preoperative planning for endonasal endoscopic approaches to the anterior skull base by overlapping endoscopic and radiologic anatomy. The important anatomic structures were marked. Morphometric measurements between these anatomic landmarks were performed endoscopically and compared with radiologic measurements of the same areas to ensure result compatibility.

Methods: Seven cadaver heads injected intravascularly with colored silicone were used for this study. Thin-section brain and paranasal sinus computed tomography scans were obtained on all cadavers. Using 0-degree rigid endoscopes and endonasal endoscopic surgical instruments, the anterior skull base was examined binostrally in all cadavers. Bilateral middle turbinates were identified and preserved. Next, an inferior uncinectomy and middle meatal antrostomy were performed. After performing a frontal antrostomy, bilateral anterior and posterior ethmoidal cells were opened and the skull base was identified and followed to the posterior wall of the frontal sinus. A transnasal transethmoidal sphenoidotomy was done with full exposure to the entire anterior skull base.

Results: The anatomic landmarks for endonasal endoscopic skull base approaches were distinguished and measurements were made. The anterior skull base was divided into 3 compartments: anterior (area between the posterior inferior border of the frontal sinus and the course of anterior ethmoidal artery), middle (area between the course of the anterior ethmoidal artery and that of the posterior ethmoidal artery [PEA]), and posterior (area between the course of the PEA and the attachment point of the anterior border of the sphenoid sinus to the skull base) compartments. The distances between important anatomic markers and endoscopic depth measurements of this area were measured.

Conclusion: During endonasal endoscopic anterior skull base surgery, the area between the anterior border of the sphenoid sinus and PEA artery was safe as the first dissection zone. Preoperative radiologic width and depth measurements facilitate orientation to the endoscopic anatomy during surgery and help predict the endonasal surgical corridor anatomy preoperatively.
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http://dx.doi.org/10.1016/j.wneu.2020.09.106DOI Listing
January 2021

Comparison of Three Surgical Approaches for Frontobasal Meningiomas: Purely Endoscopic Endonasal, Purely Microscopic Bifrontal Transcranial, and Combined Endoscopic and Microscopic Supraorbital Transciliary Approaches.

J Craniofac Surg 2020 Sep 3. Epub 2020 Sep 3.

Ankara University, School of Medicine, Department of Neurosurgery.

Surgical removal of frontobasal meningiomas (FBMs) can be achieved using different techniques, including endoscopic, transcranial, and combined approaches. The advantages and disadvantages of the outcomes of these approaches should be compared to provide the most convenient surgical treatment to the patient. This study aimed to compare 3 surgical approaches for FBMsin terms of outcomes and determine the superiority of each on the basis of anatomical, surgical, and clinical efficacy. Systematic review was performed to identify studies comparing techniques for the surgical removal of FBMs. Each group included 13 patients; 39 patients with FBMshad undergone surgery. These groups were endoscopic endonasal approach (EEA), microscopic bifrontal transcranial approach (MTA), and endoscopic plus microscopic combined supraorbital transciliary approach (STA) groups. Data on the demographics of patient population, pre- and post-operative neurological examination, tumor properties, imaging studies, and surgical complications were extracted. The mean age at the time of surgery for the patient population was 53.2 years. Among the groups, no statistically significant differences were observed with regard to sex (P = 0.582). The mean follow-up time was 56.7 months. A statistically significant difference was observed in the mean tumor volume among the groups; the MTA group showed the highest mean tumor volume. However, no significant difference was found in the mean tumor volume between EEA and STA groups. Regarding operation duration, the STA group had the shortest operation time (mean = 281.5 minutes), whereas the average surgical duration in MTA group was the longest (mean = 443.8 minutes). The average bleeding volume was highest in the MTA group (mean = 746.2 ml) and lowest in the EEA group (mean = 320.8 ml). Tumor removal was incomplete in three patients (two in the EEA group and one in the MTA group). Recurrence was detected in two cases. One patient with recurrence was operated using the endoscopic surgical approach, whereas the other patient underwent the microscopic bifrontal approach. Post-operative hyposmia/anosmia or decreased olfactory function was the most common complication observed in 5 patients, 2 patients each in the EEA and MTA groups and one in the STA group. The second most common complication was wound infection in one patient in the MTA group and two patients in the STA group (7.7%). Both cerebrospinal fluid (CSF) leakage and meningitis were present in two patients (5.1%), one patient each from the EEA and STA groups. Pre-operative visual disturbances were reported in 13 patients (33.3%), all of which resolved post-operatively No statistical differences were found among the groups. Mortality occurred in a patient in the MTA group (2.6%) caused by cardiac arrest on post-operative day 1. This is the first study comparing the surgical outcomes of three surgical approaches for FBMs. Although recent literature suggests that both endoscopic and transcranial approaches have their own advantages and disadvantages, the authors showed that none of the surgical approaches have obvious superiority over the others with regard to outcomes. Thus, the selection of the ideal surgical approach should be based on surgical experience and tumor characteristics.
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http://dx.doi.org/10.1097/SCS.0000000000006970DOI Listing
September 2020

Letter to the Editor Regarding the Article on "Turkish Board of Neurological Surgery".

Turk Neurosurg 2020 ;30(5):785

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

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http://dx.doi.org/10.5137/1019-5149.JTN.30412-20.0DOI Listing
January 2020

A skull in a skull: a child's observation.

Childs Nerv Syst 2020 08 5;36(8):1577-1578. Epub 2020 Jun 5.

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

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http://dx.doi.org/10.1007/s00381-020-04693-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7272314PMC
August 2020

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

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

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

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

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

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

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

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

Endonasal endoscopic management of the craniopharyngeal canal meningoencephalocele using a nasoseptal flap in a 6-month-old infant.

Childs Nerv Syst 2020 11 8;36(11):2883-2886. Epub 2020 Apr 8.

Department of Otolaryngology, Head and Neck Surgery, Ankara University, Sihhiye, Ankara, Turkey.

Endonasal endoscopic approach (EEA) has become a routine and effective method for the management of large skull base defects in adults and increasingly in older pediatric populations despite their challenging narrow transnasal corridors. To our knowledge, this is the first report in the literature of a large craniopharyngeal canal (CC) meningoencephalocele in a 6-month-old infant managed purely through EEA, also by utilizing a pedicled nasoseptal flap (PNF).
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http://dx.doi.org/10.1007/s00381-020-04602-wDOI Listing
November 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

MR Navigation and Tractography-Assisted Transcranial Neuroendoscopic Aspiration of Pediatric Thalamic Abscess.

Pediatr Neurosurg 2019 5;54(5):354-358. Epub 2019 Sep 5.

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

Aim: Management of thalamic abscess is being considered as a contentious issue in neurosurgery. Regarding these lesions, besides removing the abscess, the most minimal morbidity is targeted during surgery and planning.

Material And Method: A 5-year-old female presented with the symptoms of altered consciousness and left hemiparesis. Her medical history pointed out that she was being followed up for a congenital cardiac anomaly consisting of transposition of the great arteries and a ventricular septal defect. A cranial MRI revealed 2 masses with peripheral contrast enhancement in the right frontal and thalamic regions. She was operated immediately and the right frontal mass, compatible with abscess, was totally excised with frontal mini craniotomy. The patient was hospitalized and followed up under intensive parenteral antibiotics. Control cranial imaging revealed progression in the size of the thalamic abscess, which was corroborative with the increased left hemiparesis. MR tractography was obtained and the patient underwent MR navigation and tractography combined neuronavigation-assisted transcranial neuroendoscopic aspiration of the thalamic abscess.

Results: The patient was stable in the early and late postoperative periods and her hemiparesis showed a dramatic recovery with no additional neurological deficits.

Conclusion: Neuronavigation is considered as one of the techniques that aid the neurosurgeon to augment the success of surgery and minimize the morbidity, especially in critically localized lesions, i.e., eloquent areas. Combining MR navigation with MR tractography images and using them during neuronavigation to assist endoscopic procedures may decrease the surgical morbidity as much as possible.
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http://dx.doi.org/10.1159/000501914DOI Listing
March 2020

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Spinal Hydatid Cyst Disease : Challenging Surgery - an Institutional Experience.

J Korean Neurosurg Soc 2019 Mar 27;62(2):209-216. Epub 2019 Feb 27.

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

Objective: Hydatid cyst disease is caused by the parasite Echinococcus granulosus. It is rarely seen in the vertebral system, occurring at a rate of 0.2-1%. The aim of this study is to present 12 spinal hydatid cyst cases, and propose a new type of drainage of the cyst.

Methods: Twelve cases of spinal hydatid cysts, surgical operations, multiple operations, chronic recurrences, and spinal hydatic cyst excision methods are discussed in the context of the literature. Patients are operated between 2005 and 2016. All the patients are kept under routine follow up. Patient demographic data and clinicopathologic characteristics are examined.

Results: Six male and six female patients with a median age of 38.6 at the time of surgery were included in the study. Spinal cyst hydatid infection sites were one odontoid, one cervical, five thoracic, two lumbar, and three sacral. In all cases, surgery was performed, with the aim of total excision of the cyst, decompression of the spinal cord, and if necessary, stabilization of the spinal column. Mean follow up was 61.3 months (10-156). All the patients were prescribed Albendazole. Three patients had secondary hydatid cyst infection (one lung and two hepatic).

Conclusion: The two-way drainage catheter placed inside a cyst provides post-operative chlorhexidine washing inside the cavity. Although a spinal hydatid cyst is a benign pathology and seen rarely, it is extremely difficult to achieve a real cure for patients with this disease. Treatment modalities should be aggressive and include total excision of cyst without rupture, decompression of spinal cord, flushing of the area with scolicidal drugs, and ensuring spinal stabilization. After the operation the patients should be kept under routine follow up. Radiological and clinical examinations are useful in spotting a recurrence.
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http://dx.doi.org/10.3340/jkns.2017.0245DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6411577PMC
March 2019

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

Transcranial endoscopic treatment of thalamic neuroepithelial cyst: case report and review of the literature.

Br J Neurosurg 2019 Jan 12:1-4. Epub 2019 Jan 12.

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

Thalamic neuroepithelial cysts are rare, benign lesions. Thirteen cases have been published in eight articles. The most frequent symptoms are headache, hemiparesis, tremor and related signs of hydrocephalus such as gait disturbance, confusion, and Paranaud's syndrome. Surgical interventions include endoscopic fenestration, open surgery and stereotaxic biopsy or aspiration. We report a case of a 63-year-old woman who had headache and right hemiparesis for 1 week, but no hydrocephalus. We treated her with transcranial neuronavigation-guided endoscopic complete resection. The patient recovered completely after cyst removal.
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http://dx.doi.org/10.1080/02688697.2018.1552753DOI Listing
January 2019

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

Surgical Management of Spinal Arachnoid Cysts in Adults.

World Neurosurg 2019 Feb 14;122:e1146-e1152. Epub 2018 Nov 14.

Department of Neurosurgery, Goodman Campbell Brain and Spine, Indiana University, Indianapolis, Indiana, USA. Electronic address:

Background: Spinal arachnoid cysts (SACs) are uncommon lesions in the spinal canal. They are usually asymptomatic, but can occasionally cause mass effect leading to neurologic symptoms. They can be congenital or secondary to a variety of causes. They can produce a variety of neurologic symptoms including pain, weakness, sensory changes, incontinence, and more. Surgical intervention may be necessary when SACs cause symptomatic mass effect.

Methods: Thirteen consecutive patients who underwent surgical intervention for an SAC were retrospectively reviewed. The data included presenting symptoms, imaging findings, neurologic status, and follow-up.

Results: Of the 13 patients, the majority of cases were located in the thoracic spine (54%) and all but one case were located dorsally or dorsolaterally. Furthermore, 38% were located extradurally and 54% were located intradurally. Pain (80%) was the most common presenting symptom. Most patients had improvement or complete resolution of their symptoms after intervention. Extradural SACs and their capsules were completely resected, whereas intradural SACs underwent fenestration. No complications occurred in this series.

Conclusions: SACs are usually asymptomatic, but rarely cause mass effect and neurologic deficits requiring surgical intervention. Surgical intervention is tailored to the position of the cysts' dorsal or ventral locations. Pain and weakness are the most likely symptoms to improve, whereas sensory symptoms are least likely to improve.
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http://dx.doi.org/10.1016/j.wneu.2018.11.005DOI Listing
February 2019

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

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

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

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

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

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

Assessing Aneurysm Obliteration and Neck Remnants in 225 Clipped Aneurysms Using Indocyanine Green Video Angiography, Micro-Doppler Ultrasonography and Postoperative Digital Subtraction Angiography.

Turk Neurosurg 2018 ;28(6):970-978

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

Aim: To present our experience of 225 clipped aneurysms in 196 patients to compare indocyanine green video angiography (ICGVA), micro-Doppler ultrasonography (MDUSG), and postoperative digital subtraction angiography (DSA) in terms of determining aneurysm obliteration, neck remnants, and parent artery patency.

Material And Methods: This retrospective study included 196 patients (108 female and 88 male patients) treated between 2013 and 2016. In all cases, aneurysm neck remnants and vessel patency were assessed using ICG-VA and 16-Hz MDUSG. DSA was performed in every case postoperatively within the first 5 days.

Results: The mean patient age was 55.8 years (range, 31-80 years), and the mean follow-up duration was 25 months (range, 2-48 months). Of the 225 clipped aneurysms, 86 were located in the anterior cerebral artery and its branches, 103 in the bifurcation of the middle cerebral artery (MCA) and the branches of the MCA, 34 in the internal cerebral artery and its branches, 1 in the posterior inferior cerebellar artery, and 1 at the basilar apex. We observed 2 neck remnants (0.8%), 2 parent/perforating artery occlusions (0.8%), and 2 residual aneurysm fillings (0.8%). There were no striking differences among the assessed methods.

Conclusion: ICG-VA, MDUSG, and dome puncturing are all useful techniques in aneurysm surgery for assessing complete obliteration of the aneurysm. In our experience, all the 3 tools are complementary to each other, and none of them is superior to the others. We recommend the use of all 3 tools to obtain a favorable outcome.
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http://dx.doi.org/10.5137/1019-5149.JTN.21878-17.2DOI Listing
January 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

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

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

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

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

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

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

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

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

Coincidental FCoincidental Feeding Artery Aneurysm Presenting during Glioblastoma Surgery: A Case Report and Literature Revieweeding Artery Aneurysm Presenting during Glioblastoma Surgery: A Case Report and Literature Review.

Turk Neurosurg 2019 ;29(4):603-606

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

The medical literature reports an association between cerebral neoplasms and aneurysm formation. Some related aneurysms are detected during preoperative screening, whereas others are detected during or after surgery. We report a patient with de novo cerebral feeding artery aneurysm that we managed during glioblastoma surgery. We present a brief review of the literature on the coexistence of brain tumors, particularly that related to high-grade glioma and aneurysms. The literature discusses several mechanisms underlying tumor formation accompanied by aneurysm formation. Some classifications were also proposed for grouping such aneurysms. We question the necessity of the routine use of vascular imaging for patients with glioblastoma.
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http://dx.doi.org/10.5137/1019-5149.JTN.19979-17.1DOI Listing
October 2019

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

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

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

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

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

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

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