Publications by authors named "Ibrahim Colak"

11 Publications

  • Page 1 of 1

Adding Expansile Duraplasty to Posterior Fossa Decompression May Restore Cervical Range of Motion in Grade 3 Chiari Malformation Type 1 Patients.

World Neurosurg 2017 Feb 2;98:98-103. Epub 2016 Nov 2.

Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

Background: Few studies have assessed the effect of Chiari malformation type 1 (CM-1) surgical decompression on cervical lordosis and range of motion (ROM). We aimed to assess the effect of expansile duraplasty on postoperative cervical mobility and spinal stability.

Materials And Methods: This was a single-center retrospective review of prospectively collected data. Patients were included if they underwent surgical treatment for symptomatic CM-1 between the years 1999 and 2009. Cervical ROM and lordosis were assessed before and after surgery in all patients. Collected data also included clinical improvement, as well as surgical complications after the procedure. Patients were divided into 2 groups. The first group underwent a posterior fossa bony decompression alone, while the second group additionally received an expansile duraplasty. Patients were further subdivided into 3 subgroups on the basis of the severity of tonsillar herniation.

Results: A total of 76 patients fit our selection criteria. Fifty-five patients belonged to the duraplasty group. Twenty-one patients underwent bony decompression alone. The 2 groups were statistically demographically and clinically similar. There was no difference in clinical outcome or in ROM and cervical lordosis between the groups except for patients with severe tonsillar herniation (CM-I grade 3). These patients had a statistically significant improvement in their postoperative cervical motility without compromising their spinal stability.

Conclusion: Adding an expansile duraplasty to craniovertebral decompression in CM-1 patients with severe tonsillar herniation may restore cervical ROM while preserving stability and alignment. This may relieve postoperative pain and improve clinical prognosis.
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http://dx.doi.org/10.1016/j.wneu.2016.10.127DOI Listing
February 2017

When is duraplasty required in the surgical treatment of Chiari malformation type I based on tonsillar descending grading scale?

World Neurosurg 2011 Feb;75(2):307-13

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

Objective: To evaluate the effect of duraplasty based on cerebellar tonsillar descent (CTD) grade in the surgical treatment of Chiari malformation type I (CM-I).

Methods: Medical records and magnetic resonance imaging (MRI) scans of 82 patients with surgical correction of CM-I performed at the authors' clinic from 1998-2009 were reviewed. The preoperative CTD grading scale was obtained. Patients were divided two groups: duraplasty group (group 1) and nonduraplasty group (group 2). The preoperative and postoperative size of the syringomyelia cavity, Japanese Orthopaedic Association (JOA) scores, recovery rate, and postoperative complications were determined.

Results: There was 58 patients in group 1, who underwent combined foramen magnum decompression, C1 (and C2 if necessary) laminectomy, and duraplasty; the 24 patients in group 2 underwent posterior fossa decompression (PFD) alone with no dural opening performed. There were no statistically significant differences between preoperative and postoperative size of the syringomyelia cavity and JOA scores of duraplasty (group 1) and nonduraplasty (group 2) groups in CTD grades 1 and 2; in CTD grade 3, the decrease in syrinx cavity and clinical improvement were statistically better in group 1 compared with group 2 (P < 0.05). Complications in group 1 were statistically significantly increased compared with group 2 (P < 0.05).

Conclusions: This study shows that PFD and duraplasty for the treatment of CTD grade 3 Chiari malformation may lead to a more reliable reduction in the volume of concomitant syringomyelia and JOA scores. In CTD grade 1 and 2 patients, PFD without duraplasty may be performed.
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http://dx.doi.org/10.1016/j.wneu.2010.09.005DOI Listing
February 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

Transfacial approach, pedicled rhinotomy for a clival chordoma: a technical report.

Turk Neurosurg 2011 Jan;21(1):86-9

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

Clival chordomas are frequently midline structures. Due to their critical location, invasive nature and aggressive recurrences, skull base chordomas are difficult to manage surgically. We present a case operated on with the pedicled transnasal and transfacial approach. The case presented with neurological deficits as cranial nerve palsy and findings of brainstem compression. The lesion was removed without any neurological deficit. Her deficits related to brainstem compression regressed after surgery. In our case, a large exposure was achieved through a lateral nasal incision in order to excise the tumor totally with acceptable cosmetic results, and a successful outcome was observed during the postoperative follow-up period with the surgical procedure applied.
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January 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

Linezolid treatment of shunt-related cerebrospinal fluid infections in children.

J Neurosurg Pediatr 2010 May;5(5):443-8

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

Object: The emergence of multidrug-resistant bacteria as a cause of ventriculoperitoneal (VP) shunt infection is a disconcerting phenomenon that often requires the use of alternative antimicrobial agents due to resistance against commonly used medications. Linezolid, a member of a new class of antimicrobial agents, has good activity against virtually all important gram-positive pathogens, including multidrug-resistant gram-positive pathogens. The object of this article is to report a single-center experience with linezolid treatment in 6 young patients with VP shunt infections caused by drug-resistant strains.

Methods: The authors reviewed the records of 6 pediatric patients who developed VP shunt infection and in whom initial antimicrobial treatment regimens, including vancomycin, either failed or were associated with vancomycin-resistant enterococcus. All 6 patients were treated at their hospital between July 1, 2008, and June 29, 2009. The patients' demographic and clinical characteristics, underlying diseases, clinical manifestations, laboratory results, and various treatment modalities used before linezolid therapy were evaluated.

Results: The 6 patients included were 2 boys and 4 girls with a mean (+/- SD) age of 11.83 +/- 12 months (range 4-36 months). Five patients had acquired an infection within 4 months (mean 7.50 +/- 13.51 months, range 1-35 months) after shunt insertion. Four patients were treated with external ventricular drainage. Two patients' parents refused to allow shunt removal and placement of an external ventricular drain. The CSF was clear of bacterial growth within a mean of 3.67 +/- 1.36 days (range 2-6 days) after initiation of linezolid treatment. The mean duration of linezolid treatment was 18.17 +/- 3.31 days (range 14-21 days). Microbiological clearance of CSF and clinical cure were achieved in all patients. No laboratory or clinical side effects were observed during the treatment period. The mean length of hospital stay was 22.8 +/- 4.96 days (range 17-28 days).

Conclusions: Linezolid could be an appropriate treatment alternative in children with ventriculostomy-related CSF infections caused by drug-resistant strains, including cases in which shunt removal is not an option. Well-designed prospective studies providing additional information on linezolid levels in plasma and CSF are necessary to confirm the authors' observations.
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http://dx.doi.org/10.3171/2009.12.PEDS09421DOI Listing
May 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

Brain abscess: analysis of results in a series of 51 patients with a combined surgical and medical approach during an 11-year period.

Neurosurg Focus 2008 ;24(6):E9

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

Object: In this study the authors' goal was to present the clinical and imaging results of the combined surgical and medical treatment of intracranial abscesses.

Methods: The authors retrospectively analyzed the data in 51 patients with intracranial abscesses who underwent surgery between January 1997 and November 2007. Patients were treated with aspiration through a single bur hole, total resection with open craniotomy, or image-guided stereotactic aspiration. Computed tomography or magnetic resonance imaging was performed approximately 24 hours after surgery to evaluate the size of the abscess and almost weekly during follow-up until the abscess and/or cerebral edema was reduced. Clinical results were analyzed using modified Rankin Scale (mRS) scores.

Results: There were 36 male and 15 female patients, and their ages ranged from 14 months to 58 years (mean 29 years). Adjacent localized cranial infection was the most common predisposing factor in 31 patients (61%). Thirty-two patients were treated by repeated aspiration via a single bur hole. Streptococcus and Staphylococcus species were isolated most frequently. No statistically significant difference between causative organisms and clinical outcome was identified (p > 0.05). Assessment of overall 1-year clinical outcomes was favorable (mRS Scores 0-2) in 76.5% of patients (39 of 51 patients). The initial neurological condition was strongly correlated with the clinical outcome (p < 0.001).

Conclusions: A combination of surgical aspiration or removal of all abscesses > 2.5 cm in diameter, a 6-week or longer course of intravenous antibiotics, and weekly neuroimaging should yield cure rates of > 90% in patients with intracranial abscesses.
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http://dx.doi.org/10.3171/FOC/2008/24/6/E9DOI Listing
December 2008

A long-term follow-up study of anterior tibial allografting and instrumentation in the management of thoracolumbar tuberculous spondylitis.

J Neurosurg Spine 2008 Jan;8(1):30-8

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

Object: The purpose of this study was to determine the efficacy of anterior instrumentation following radical debridement and tibial allografting and its long-term progression in patients with multilevel spinal tuberculosis.

Methods: This prospective observational study was undertaken to analyze 22 patients with multilevel spinal tuberculosis (Pott disease) who underwent anterior radical debridement, decompression, and fusion using anterior spinal instrumentation and tibial allograft replacement between 1999 and 2001. Clinical outcomes were assessed using the American Spinal Injury Association (ASIA) Impairment Scale and a visual analog scale (VAS). Preoperative and postoperative plain radiographs were obtained, and the focal kyphotic angle of the surgically treated spinal segments and the overall sagittal and coronal contours of the thoracic and lumbar spine were evaluated in all patients.

Results: The mean follow-up time was 84 months (range 36-96 months). All patients demonstrated clinical healing of the tuberculosis infection. All patients showed evidence of successful bone fusion. The mean late postoperative kyphosis correction was 74% (range 63-91%). On average, 2 degrees (range 0-5 degrees ) of loss of correction was noted in the local kyphotic angle postoperatively in late follow-up findings. Evaluation of the surgical effect on sagittal global contours showed a significant correction rate in thoracic, thoracolumbar, and lumbar regions. The mean late postoperative coronal plane alignment correction was 99%. The ASIA Impairment Scale scores demonstrated significant improvement in late follow-up results in our series. Surgical decompression also resulted in a dramatic reduction of overall pain in all patients (late postoperative VAS score 1.61 +/- 0.81).

Conclusions: Anterior tibial allografting and instrumentation provide correction of the curvature, prevention of further deformation, improvement of sagittal and coronal balance, and restoration of neurological function in patients with spinal tuberculosis.
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http://dx.doi.org/10.3171/SPI-08/01/030DOI Listing
January 2008

Efficacy of unilateral laminectomy for bilateral decompression in lumbar spinal stenosis.

Turk Neurosurg 2007 Apr;17(2):100-8

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

Objective: We have conducted a prospective study to evaluate the results and effectiveness of bilateral decompression via a unilateral laminectomy in 50 patients with 98 levels of degenerative lumbar spinal stenosis without instability.

Methods: Clinical outcomes were assessed using the Visual Analog Scale, Oswestry Disability Index, Short Form-36, and subjective Satisfaction Measurement.

Results: Adequate decompression was achieved in all patients. The mean follow-up time was 22.8 months (range 19 - 47 months). Surgical decompression resulted in a dramatic reduction of overall pain in all patients (late postoperative VAS score was 2.16 +/- 0.81). The ODI scores decreased significantly in early and late follow-up evaluations and the SF-36 scores demonstrated significant improvement in late follow-up results in our series. Patient satisfaction rate was 94%, and its improvement rate was 96%.

Conclusion: For degenerative lumbar spinal stenosis with or without mild degenerative spondylolisthesis, the unilateral approach allowed sufficient and safe decompression of the neural structures and adequate preservation of vertebral stability, resulted in a highly significant reduction of symptoms and disability, and improved health-related quality of life.
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April 2007

Midterm outcome after unilateral approach for bilateral decompression of lumbar spinal stenosis: 5-year prospective study.

Eur Spine J 2007 Dec 22;16(12):2133-42. Epub 2007 Aug 22.

Department of Neurosurgery, Sişli Etfal State Hospital, 34303, Istanbul, Turkey.

The aim of our study is to evaluate the results and effectiveness of bilateral decompression via a unilateral approach in the treatment of degenerative lumbar spinal stenosis. We have conducted a prospective study to compare the midterm outcome of unilateral laminotomy with unilateral laminectomy. One hundred patients with 269 levels of lumbar stenosis without instability were randomized to two treatment groups: unilateral laminectomy (Group 1), and laminotomy (Group 2). Clinical outcomes were assessed with the Oswestry Disability Index (ODI) and Short Form-36 Health Survey (SF-36). Spinal canal size was measured pre- and postoperatively. The spinal canal was increased to 4-6.1-fold (mean 5.1 +/- SD 0.8-fold) the preoperative size in Group 1, and 3.3-5.9-fold (mean 4.7 +/- SD 1.1-fold) the preoperative size in Group 2. The mean follow-up time was 5.4 years (range 4-7 years). The ODI scores decreased significantly in both early and late follow-up evaluations and the SF-36 scores demonstrated significant improvement in late follow-up results in our series. Analysis of clinical outcome showed no statistical differences between two groups. For degenerative lumbar spinal stenosis unilateral approaches allowed sufficient and safe decompression of the neural structures and adequate preservation of vertebral stability, resulted in a highly significant reduction of symptoms and disability, and improved health-related quality of life.
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http://dx.doi.org/10.1007/s00586-007-0471-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2140122PMC
December 2007