Publications by authors named "Halit Cavuşoglu"

40 Publications

Diagnosis and Treatment of Transforaminal Epidural Steroid Injection in Lumbar Spinal Stenosis.

Sisli Etfal Hastan Tip Bul 2020 24;54(3):327-332. Epub 2020 Aug 24.

Fulya Hospital, Acıbadem Healthcare Group, Istanbul, Turkey.

Objectives: Transforaminal epidural steroid injection reduces the low back-leg pain and enables daily activities of the patients. In this study, we aim to evaluate the treatment of transforaminal epidural steroid injection for lumbar spinal stenosis, which was mainly performed for lumbar disc herniation and share our diagnostic experience for lumbar spinal stenosis which is treated surgically.

Methods: In our study, 37 patients were included who were treated by transforaminal epidural steroid injection for Grade B lumbar spinal stenosis in our clinic between June-2014 and June-2018. We evaluated the patients at the second weeks, third/sixth months and one year after the treatment by Oswestry-Disability-Index and Visual-Analogue-Scale and followed up for surgical treatment after one year.

Results: The mean low back and leg pain Visual Analogue Scale was 5.1±0.3 before the transforaminal epidural steroid injection procedure, and it was 2.7±0.1 after two weeks. It was 2.8±0.2, 3.1±0.1 at three and six months after procedure, respectively. The improvement of low back-leg pain mean Visual-Analogue-Scale is statistically significant at two weeks, three and six months after transforaminal epidural steroid injection procedure, respectively. The mean Oswestry-Disability-Index was 29.6±0.4 before the transforaminal epidural steroid injection procedure, and it was 14.1±0.3 after two weeks. It was 15.3±0.5, 24.4±0.2 at three and six months after procedure, respectively. The improvement of Oswestry-Disability-Index is statistically significant at two weeks, three-six months.

Conclusion: The transforaminal epidural steroid injection is safe procedure for non-surgical treatment of lumbar spinal stenosis and this procedure may be preferred support to the indication of the surgical treatment of level of lumbar spinal stenosis.
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http://dx.doi.org/10.14744/SEMB.2020.89983DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7729724PMC
August 2020

Surgical Outcomes of Extraforaminal Microdiskectomy by Midline Incision for Far-Lateral Lumbar Disk Herniation.

J Neurol Surg A Cent Eur Neurosurg 2021 Jan 6;82(1):27-33. Epub 2020 Nov 6.

Acibadem Healthcare Group, Fulya Hospital, Istanbul, Turkey.

Background:  Far-lateral lumbar disk herniation (FLDH) is defined as a disk herniation located laterally to the medial wall of the pedicle. The aim of our study is to describe the extraforaminal microdiskectomy by midline incision for FLDH, which does not include laminotomy-partial facetectomy, and to evaluate mid-term surgical outcomes.

Methods:  107 patients who underwent surgery for FLDH by midline incision for the first time between 2012 and 2017 were included in our study. The assessment of neurological status of the patients was done by physical examination, preoperative Oswestry Disability Index (ODI), Visual Analog Scala (VAS) scores, and magnetic resonance images. They were then followed-up postoperatively and at 12 months with VAS and ODI tests.

Result:  58 (54.2%) patients were male and 49 (45.8%) were female. The mean age at the time of surgery was 55.0 ± 8.6 years. The mean ODI scale score was 32.4 ± 6.2 preoperatively, 11.4 ± 2.1 early postoperatively, and 9.7 ± 2.2 in late postoperative follow-up (statistically significant,  = 0.001). The average VAS was 7.51 ± 1.1 preoperatively, 2.74 ± 0.7 early postoperatively, and 0.68 ± 0.08 in late postoperative follow-up (statistically significant,  = 0.001). The average operative time was 41 ± 7 (37 to 58) minutes.

Conclusions:  The extraforaminal microdiskectomy without laminotomy by midline incision is a minimally invasive approach for FLDH. Our technique allows a sufficient and safe decompression of the neural structures, and thus results in a significant reduction of the symptoms and disability.
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http://dx.doi.org/10.1055/s-0040-1714367DOI Listing
January 2021

Minimally Invasive Open Surgical Approach and Outcomes for Carpal Tunnel Syndrome.

Sisli Etfal Hastan Tip Bul 2019 26;53(3):247-251. Epub 2019 Aug 26.

Acibadem Healthcare Group, Fulya Hospital, Neurosurgery, Istanbul, Turkey.

Objectives: The most common peripheral neuropathy is carpal tunnel syndrome. The present study aims to describe our minimally invasive open surgical approach for carpal tunnel syndrome and evaluate surgical outcomes.

Methods: We included 217 patients who were operated in our clinic for carpal tunnel syndrome by minimally invasive open surgical approach. Visual Analogue Scale and Functional Outcome Scale scores were obtained preoperative, postoperative at one month and three months to determine surgical outcomes.

Results: The mean age of the patients was 55.4±12.8 years (32 to 69), 175 (80.6%) were women and 42 (19.4%) were men. The assessment of carpal tunnel syndrome's etiology showed that 189 (%87.1%) of the cases were idiopathic, 19 (8.8%) had hypothyroidism, 5 (2.3%) had rheumatoid arthritis and 4 (1.8%) were due to pregnancy. The average improvement of VAS between preoperatively and late postoperatively was 5.41±1.05. The average improvement FOS was 17.44±3.06. They were statistically significant.

Conclusion: The minimally invasive open surgical approach for carpal tunnel syndrome (an average of 1 cm skin incision) is performed with local anesthesia and successful surgical outcomes are achieved.
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http://dx.doi.org/10.14744/SEMB.2019.94759DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7192267PMC
August 2019

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

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

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

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

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

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

Conclusion: The findings obtained in this study suggest that high resection rates can be achieved with appropriate surgical intervention in orbital tumors requiring a transcranial surgical approach. The most important factor in surgical planning is the location of the tumor. The size of the tumor and the expectation of the percentage of surgical removal are the other important factors. In our series, it has reached high excision ratio in most cases with low complication rate, good visual field and eye movements results.
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http://dx.doi.org/10.14744/SEMB.2018.82698DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7192274PMC
August 2019

Letter: Contralateral Minimally Invasive Laminectomy for Resection of a Synovial Cyst: 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2020 06;18(6):E258-E259

Vocational School of Health Services Acıbadem Mehmet Ali Aydınlar University Istanbul, Turkey.

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http://dx.doi.org/10.1093/ons/opaa046DOI Listing
June 2020

Ultrasound-Guided Microsurgical Excision for Brachial Plexus Schwannomas: Short-Term Clinical Study.

Turk Neurosurg 2019 ;29(4):594-597

Acibadem Mehmet Ali Aydinlar University, Vocational School of Health Services, Istanbul, Turkey.

Aim: To describe the ultrasound-guided microsurgical excision technique and to evaluate the surgical outcomes of brachial plexus schwannomas.

Material And Methods: Eleven patients who underwent ultrasound-guided microsurgery for small ( < 3 cm) brachial plexus schwannomas between 2013 and 2017 were included in our study.

Results: The mean age of the patients was 45 years (range: 30-68 years), with six tumors localized on the right and five on the left side. There were no perioperative or postoperative complications. No postoperative deficits were observed in the patients.

Conclusion: Surgeons can safely and completely excise most of the benign ( < 3 cm and non-palpable) brachial plexus tumors by the ultrasound-guided microsurgical excision technique.
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http://dx.doi.org/10.5137/1019-5149.JTN.25575-18.3DOI Listing
October 2019

Surgical outcome and efficacy of lumbar microdiscectomy technique with preserving of ligamentum flavum for recurrent lumbar disc herniations.

J Clin Neurosci 2019 May 1;63:43-47. Epub 2019 Mar 1.

Acıbadem Healthcare Group, Fulya Hospital, Istanbul, Turkey.

The reoperation for recurrent lumbar disc herniation (LDH) causes difficulties and low surgical outcome. The operation technique which was preferred in the first surgery has gained importance in reoperation for recurrent-LDH. The aim of our study is to evaluate the efficacy of lumbar microdiscectomy technique with preserving of ligamentum flavum (LF) for recurrent lumbar disc surgery. 149 patients were evaluated in two groups in our study, who were treated for single level recurrent-LDH in our clinic. The first group contains 86 patients who were treated by lumbar microdiscectomy without preserving LF during first surgery in other clinics, the second group contains 63 patients who were treated by lumbar microdiscectomy with preserving of LF during first surgery in our clinic. We investigated age, weight, gender, recurrence-time, level-side of recurrent-LDH, the surgical outcomes and hemorrhage, complications, operation-time. The mean-age was 45,9 ± 12,9, 44,1 ± 11,6 years and mean-weight was 73,4 ± 14,4, 77,3 ± 14,2 kg in two groups. 29 patients were treated for L3-4, 63 patients for L4-5, 57 patients were treated for L5-S1 recurrent LDH. The preoperative and follow-up back-leg pain Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) scores decreased significantly in all patients (p < 0,05). The average operation-time was 70,9 ± 5,2 and 42,3 ± 4,6 min and the average surgical hemorrhage was 91,1 ± 11,3 and 50,3 ± 7,4 ml in 1. group and 2. group respectively. Preserving of LF in first surgery is gaining importance for recurrent lumbar disc surgery with protected anatomical structures. Our technique decreases complication, operation time, surgical hemorrhage and provides good surgical outcomes in recurrent lumbar disc surgery.
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http://dx.doi.org/10.1016/j.jocn.2019.02.010DOI Listing
May 2019

Long-Term Clinical Outcome and Reoperation Rate for Microsurgical Bilateral Decompression via Unilateral Approach of Lumbar Spinal Stenosis.

World Neurosurg 2019 05 31;125:e465-e472. Epub 2019 Jan 31.

Acıbadem Healthcare Group, Fulya Hospital, Istanbul, Turkey.

Objective: To evaluate long-term outcome and reoperation rate for microsurgical bilateral decompression via unilateral approach of lumbar spinal stenosis, a common degenerative spinal disease of the lumbar spine.

Methods: In this observational prospective study, 918 patients were treated for single-level or multilevel lumbar spinal stenosis by bilateral decompression via unilateral approach between January 2002 and January 2016. Of 918 patients, 180 underwent microdiscectomy with decompression. Follow-up consisted of radiologic investigations, Oswestry Disability Index questionnaire, and 36-Item Short-Form Health Survey at 6 and 12 months postoperatively.

Results: There were 492 female patients (53.6%) and 426 male patients (46.4%) with a mean age of 63.83 ± 10.16 years (range, 43-79 years). Symptom duration was 4-49 months. Average follow-up time was 98 months (range, 25-168 months), and reoperation rate was 2.5%. Oswestry Disability Index scores decreased significantly (from 30.65 ± 7.82 to 11.32 ± 2.50 at 6 months and 11.30 ± 2.49 at 12 months), and 36-Item Short-Form Health Survey parameter scores demonstrated a significant improvement in the early and late follow-up results.

Conclusions: Bilateral decompression via unilateral approach for lumbar spinal stenosis allowed a sufficient and safe decompression of the neural structures, resulting in a highly significant reduction of symptoms and disability, acceptable reoperation rate, and improved health-related quality of life.
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http://dx.doi.org/10.1016/j.wneu.2019.01.105DOI Listing
May 2019

Midterm outcome of thoracic disc herniations that were treated by microdiscectomy with bilateral decompression via unilateral approach.

J Clin Neurosci 2018 Dec 9;58:94-99. Epub 2018 Oct 9.

Acıbadem Mehmet Ali Aydınlar University, Fulya Hospital, Department of Neurosurgery, Istanbul, Turkey.

Thoracic disc herniation (TDH) surgery carries risks of neurological worsening due to thoracic cord retraction injury. Multiple approaches have been developed aiming for resecting the disc herniations of the thoracic segment. We have conducted a prospective observational study to evaluate the mid-term outcome of thoracic microdiscectomy with bilateral decompression via a unilateral approach (BDUA). Patients were checked pre-operative, post-operative, and late follow-up by Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), and radiological images. Twenty-three patients were treated for TDH by microdiscectomy with BDUA between January 2010 and January 2015. Nine patients were female, fourteen were male, and all of those mean age was 51,2 ± 8,3 (range 29-64 years). The mean follow-up time was 22,04 ± 8,59 months (range 13-58 m). The ODI and VAS scores decreased significantly in both postoperative and late follow-up evaluations. Microdiscectomy with BDUA for thoracic disc herniations allowed sufficient and safe decompression of the neural structures and resulted in a significant reduction of symptoms and disability.
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http://dx.doi.org/10.1016/j.jocn.2018.09.033DOI Listing
December 2018

A Prospective Study of Interbody Fat Graft Application With the Anterior Contralateral Cervical Microdiscectomy to Preserve Segmental Mobility.

Neurosurgery 2017 Oct;81(4):627-637

Clinic of Neurosurgery, Acibadem University, Acibadem Fulya Hospital, Istanbul, Turkey.

Background: Any surgical procedure aims at protecting mobile segments at the operated level, and the sagittal balance of the columna vertebralis. Interbody fusion has become an often applied technique in anterior cervical discectomy.

Objective: To indicate that a minimally invasive technique in which we use interbody fat graft placement showed great results and effectiveness, especially in patients who were suffering from cervical paramedian disc herniation.

Methods: In this study, 432 patients were observed from 2000 to 2013. All these consecutive patients had paramedian disc herniation. The initial 239 patients (group 1) underwent microdiscectomy without graft placement, whereas the remaining 193 patients (group 2) had a microdiscectomy with interbody fat graft insertion. The Neck Disability Index (NDI) and Short Form-36 (SF-36) were used to evaluate clinical outcomes. They were followed up for 5.3 years (range 2-13 years).

Results: Spontaneous radiological fusion was noticed in 12% of group 1 patients and none of the group 2 patients. It has been observed that the mean overall cervical curvature (C2-7) angles and segmental lordosis did not change significantly in late follow-up findings. During both early and late follow-ups, all patients indicated a decreasing NDI score, but in late follow-up, an improving SF-36 score.

Conclusion: This surgical technique provides good direct decompression and preserves mobility at the treated level, while preventing disc collapse.
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http://dx.doi.org/10.1093/neuros/nyx056DOI Listing
October 2017

Retraction: Gold nanoparticles immobilized on electrospun titanium dioxide nanofibers for catalytic reduction of 4-nitrophenol.

Chemphyschem 2017 Feb 13. Epub 2017 Feb 13.

Technical Chemistry I and Center of Nanointegration Duisburg-Essen (CENIDE), Essen, Germany, GERMANY.

This study involves the preparation and catalytic properties of anatase titanium dioxide nanofibers (TiO2 NFs) supported gold nanoparticles (Au NPs) using a model reaction based on the reduction of 4-nitrophenol (NP) into 4-aminophenol (AP) by sodium borohydride (NaBH4). The fabrication of surfactant-free Au NPs was performed using pulsed laser ablation in liquid (PLAL) technique. The TiO2 NFs were fabricated by a combination of electrospinning and calcination process using a solution containing poly(vinyl pyrolidone)(PVP) and titanium isopropoxide. The adsorption efficiency of laser-generated surfactant-free Au NPs to TiO2 NF supports as a function of pH was analyzed. Our results show that the electrostatic interaction mainly controls the adsorption of the nanoparticles. Au NPs/TiO2 NFs composite exhibited good catalytic activity for the reduction of 4-NP to 4-AP. The unique combination of these materials leads to the development of highly efficient catalysts. Our heterostructured nanocatalysts possibly form an efficient path to fabricate various metal NP/metal-oxide supported catalysts. Thus the applications of PLAL-noble metal NPs can widely broaden.
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http://dx.doi.org/10.1002/cphc.201601318DOI Listing
February 2017

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

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

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

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

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

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

Conclusion: CT-guided stereotactic biopsy is a reliable and a safe procedure in cases with intracranial lesions when histopathological diagnosis is required for the appropriate treatment.
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http://dx.doi.org/10.5137/1019-5149.JTN.16280-15.1DOI Listing
December 2017

Novel capsules for potential theranostics of obscure gastrointestinal bleedings.

Med Hypotheses 2016 Sep 12;94:99-102. Epub 2016 Jul 12.

Advanced Technology Research and Application Center, Selcuk University, Konya, Turkey; Department of Metallurgy and Materials Engineering, Selcuk University, Konya, Turkey. Electronic address:

Obscure gastrointestinal (GI) bleeding is identified as persistent or repeated bleeding from the gastrointestinal tract which could not be defined by conventional gastrointestinal endoscopy and radiological examinations. These GI bleedings are assessed through invasive diagnostic and treatment methods including enteroscopy, angiography and endoscopy. In addition, video capsule endoscopy (VCE) is a non-invasive method used to determine the location of the bleeding, however, this does not provide any treatment. Despite of these successful but invasive methods, an effective non-invasive treatment is desperately needed. Herein, we prepare non-invasive theranostic capsules to cure obscure GI bleeding. An effective theranostic capsule containing endothelin as the targeting agent, thrombin-fibrinogen or fibrin as the treating agent, and fluorescein dye as the diagnostic tool is suggested. These theranostic capsules can be administered orally in a simple and non-invasive manner without a risk of complication. By using these novel capsules, one can diagnose obscure GI bleeding with having a possibility of curing.
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http://dx.doi.org/10.1016/j.mehy.2016.07.006DOI Listing
September 2016

Arachnoid cyst of the cerebellopontine angle causing isolated acute hearing loss, with literature review.

Acta Neurochir (Wien) 2015 Nov 2;157(11):1999-2001. Epub 2015 Sep 2.

Clinic of Neurosurgery, Acibadem Fulya Hospital, İstanbul, 34349, Turkey.

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http://dx.doi.org/10.1007/s00701-015-2563-9DOI Listing
November 2015

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

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

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

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

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

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

Conclusions: If patients are carefully selected and individually assigned to their optimum treatment modality, IUAs can be obliterated by surgery with a low percentage of unfavorable outcomes.
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http://dx.doi.org/10.1007/s00701-012-1397-yDOI Listing
July 2012

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

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

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

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

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

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

Conclusion: A unilateral subfrontal interhemispheric transfalcial approach can be the preferred modality for treating OGM.
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http://dx.doi.org/10.5137/1019-5149.JTN.4749-11.1DOI Listing
July 2012

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

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

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

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

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

Conclusion: Although some authors do not propose routine additional follow-up in adults after the initial negative postoperative angiogram, we believe that such patients should be followed clinically and radiologically.
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http://dx.doi.org/10.5137/1019-5149.JTN .3059-10.2DOI Listing
April 2012

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

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

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

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

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

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

Conclusions: Postoperative clinical improvement and radiological findings clearly demonstrated that the unilateral approach for treating 1-level and multilevel lumbar spinal stenosis with DS is a safe, effective, and minimally invasive method in terms of reducing the need for stabilization.
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http://dx.doi.org/10.3171/2011.7.SPINE11222DOI Listing
January 2012

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

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

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

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

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

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

Conclusions: This study shows that patients with severe visual impairment may have remarkable improvement if surgical decompression is done early. The transsphenoidal approach should be performed to correct the patient's visual impairment and to relieve the pressure on the optic apparatus caused by macroadenoma of any size.
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http://dx.doi.org/10.1016/j.wneu.2011.02.009DOI Listing
October 2011

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

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

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

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

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

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

Conclusion: Posterior fossa AVMs present an increased risk for hemorrhage and for increased morbidity and mortality. Cases with hematoma should be operated on an urgent basis. We conclude that hematoma volume is a factor that impacts postoperative results and prognosis. SMG and preoperative mRS scores were also correlated with outcome.
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http://dx.doi.org/10.5137/1019-5149.JTN.3401-10.0DOI Listing
September 2011

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

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

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

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

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

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

Conclusions: Based on early clinical outcomes and the fusion ratios of adult isthmic spondylolisthesis, the authors found PLIF to be superior to PLF.
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http://dx.doi.org/10.3171/2010.11.SPINE10281DOI Listing
April 2011

Shunt insertion in newborns with myeloschisis/myelomenigocele and hydrocephalus.

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

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

We compared two strategies for treating newborns with myeloschisis or myelomeningocele (open neural tube defect [oNTD]) and hydrocephalus. These strategies involved insertion of a ventriculo-peritoneal shunt (VPS) either synchronous with or sequential to surgical closure of the oNTD. We investigated shunt infection and cerebrospinal fluid (CSF) leakage rates and their effects on the duration of hospitalization for both treatments. The study involved 65 patients with hydrocephalus and open neural placodes which were covered with a thin pseudomembrane. Thirty-eight infants underwent an oNTD repair operation and shunting during the same surgical session (synchronous group [group 1]), and 27 infants underwent sequential procedures, in which shunt insertion was delayed until the thoracolumbar wound was partially healed (sequential group [group 2]). Group 1 had a mean duration of hospital stay of 15.5 days, significantly less than the average 28.8 days of group 2 (p < 0.05). No significant differences in CSF leakage and shunt infections occurred between the two groups (p > 0.05). The incidence of shunt infection due to CSF fistulas that developed postoperatively was higher for patients with CSF leakage as a result of oNTD at birth than for patients without CSF leakage (p < 0.05). Patients with oNTD are at significant risk of infections because of the thin pseudomembrane over the defect. In addition, newborn patients may also have a weakened immune system. Despite these disadvantages, VPS placement within a single session can be advantageous for the patient, family and physician, compared to multiple surgical procedures. It is also more cost-effective.
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http://dx.doi.org/10.1016/j.jocn.2010.03.042DOI Listing
December 2010

Value of early unilateral decompressive craniectomy in patients with severe traumatic brain injury.

Ulus Travma Acil Cerrahi Derg 2010 Mar;16(2):119-24

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

Background: The aim of our study was to evaluate the results and effectiveness of early decompressive craniectomy in the treatment of severe traumatic brain injury.

Methods: We conducted a prospective study to investigate the clinical and radiological results of early unilateral decompressive craniectomy in 33 patients with severe traumatic brain injury. The mean area of the craniectomy, potential expansion volume of the decompressed brain, and distance between the lower border of the craniectomy and the temporal cranial base were calculated from computed tomography scans. Clinical results were analyzed with modified Rankin Scale (mRS).

Results: Time to surgery after trauma was 3.1+/-1.9 hours. There was a direct proportionality correlation between the area of the craniectomy and the calculated volume (p<0.0001). There was also a significant correlation between the state of the mesencephalic cisterns after craniectomy and the distance of the craniectomy to the base of the cranium (p<0.01). Assessment of overall one-year clinical outcome demonstrated favorable outcome (mRS 0-3) in 48.5% of patients.

Conclusion: The high overall morbidity and mortality rates demonstrated in our group despite the performance of early decompressive procedures reflect the severity of the underlying injuries.
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March 2010

Meningioma causing hyperostosis of the cranial convexity in a child.

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

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

We present an 8-year-old girl with meningioma-associated hyperostosis. The patient was referred to our clinic due to headache and a frontoparietal midline swelling that was more prominent on the right side of the cranium. A cranial MRI revealed a frontoparietal parasagittal meningioma, accompanied by a diffuse hyperostosis, that appeared to extend extracranially. She underwent a right frontoparietal craniotomy and the tumor, together with the affected bone, was successfully removed. The histological examination confirmed meningioma (World Health Organization 2007 Grade 1) in the intracranial and extracranial lesions. Meningioma causing hyperostosis in a child is rare. The precise mechanism of hyperostosis associated with meningioma remains unclear; however, the most widely accepted theory is that the tumor invades the bone.
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http://dx.doi.org/10.1016/j.jocn.2009.11.008DOI Listing
July 2010

The impact of automatic retractors on the esophagus during anterior cervical surgery: an experimental in vivo study in a sheep model.

J Neurosurg Spine 2009 Nov;11(5):547-54

Neurosurgery Clinic, Veterinary Faculty, Istanbul University, Istanbul, Turkey.

Object: Postoperative dysphagia is a well-recognized complication of the anterior surgical approach to the cervical spine. However, its incidence and etiology remain unknown. The aim of this study was to investigate the impact of automatic retractor use on the esophagus and to describe the related pathological changes that might occur during cervical spine surgery.

Methods: A single-level cervical discectomy was performed via an anterior approach in 16 skeletally mature female sheep. Continuous retraction was applied with an automatic retractor system during surgery. The sheep model was chosen because of anatomical similarities to the human esophagus. The esophageal tract in every animal was examined using contrast radiographic examination. Eight animals were killed 3 days after the operation (Group 1). The remaining sheep were killed 4 weeks after the operation (Group 2). The esophagi were removed for histopathological study, which was performed using H & E and Masson trichrome staining. The changes in esophageal innervation were examined with nicotinamide adenine dinucleotide diphosphate-diaphorase histochemical staining.

Results: Only 1 animal (a Group 1 sheep) demonstrated any postoperative radiographic abnormality. In Group 1 sheep, histopathological study of the esophagi at the treated level revealed edema between the muscular fibers in the outer longitudinal and inner circular layers of the muscularis propria. At some points, obvious signs of vascular congestion, vascular damage, and inflammation were observed. In the Group 2 animals, there was mild-to-moderate fibrosis extending from the outer surface of the esophagus to the longitudinal layers of the muscularis propria in the area to which retraction had been applied. Enzyme-histochemical staining revealed the presence of normal myenteric plexus and ganglion cells, and nitrergic innervation in all parts of the esophagus wall.

Conclusions: The results of this study demonstrate that direct pressure induced by the medial retractor blade on the esophagus wall leads to local injury. Postoperative dysphagia in human patients who have undergone anterior cervical spine surgery could be a clinical manifestation of this phenomenon.
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http://dx.doi.org/10.3171/2009.6.SPINE09216DOI Listing
November 2009

Isolated posterior spinal artery aneurysm causing intracranial acute subarachnoidal hemorrhage.

Acta Neurochir (Wien) 2010 Apr 20;152(4):721-4. Epub 2009 Aug 20.

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

A case of an isolated posterior spinal artery aneurysm of the upper cervical spinal cord is presented. Spinal artery aneurysms that are not associated with other entities are extremely rare. Four cases have been reported in the literature to date. The patient developed symptoms and signs of intracranial subarachnoid hemorrhage. The aneurysm was successfully clipped. No other vascular abnormalities were seen.
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http://dx.doi.org/10.1007/s00701-009-0491-2DOI Listing
April 2010

Multiple intracranial hydatid cysts in a boy.

Turk Neurosurg 2009 Apr;19(2):203-7

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

Multiple hydatid cysts of the brain are uncommon and may be either primary or secondary. A 15-year-old boy with a huge mass of intracranial hydatid cysts (95x85x80 mm) is presented. The first manifestation was headache and vomiting, which was followed by symptoms of raised intracranial pressure. The patient underwent an urgent operation due to rapidly deteriorating neurological status, and 19 hydatid cysts were removed. Unfortunately, the patient's neurological status did not improve and he died. Hydatid cyst is a benign lesion. Surgery is the standard and most effective treatment for intracranial hydatid cysts. Appropriate and timely management is mandatory for reducing the mortality and morbidity.
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April 2009

Pigmented villonodular synovitis of a lumbar intervertebral facet joint.

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

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

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

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

Study Design: Case report.

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

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

Conclusions: The principle of surgical management of spinal lesions causing neurologic deficit is early surgical decompression. It is also important to totally remove the synovium, the origin of PVNS, to prevent the recurrence.
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http://dx.doi.org/10.1016/j.spinee.2008.12.010DOI Listing
August 2009

Spinal stenosis.

J Neurosurg Spine 2008 Aug;9(2):231-3; author reply 233

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http://dx.doi.org/10.3171/SPI/2008/9/8/231DOI Listing
August 2008