Publications by authors named "Mehmet Senoglu"

36 Publications

The benefits of inferolateral transtubercular route on intradural surgical exposure using the endoscopic endonasal transclival approach.

Acta Neurochir (Wien) 2021 Apr 13. Epub 2021 Apr 13.

Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey.

Background: Surgical access to the ventral pontomedullary junction (PMJ) can be achieved through various corridors depending on the location and extension of the lesion. The jugular tubercle (JT), a surgically challenging obstacle to access the PMJ, typically needs to be addressed in transcranial exposures. We describe the endoscopic endonasal transclival approach (EETCA) and its inferolateral transtubercular extension to assess the intradural surgical field gained through JT removal. We also complement the dissections with an illustrative case.

Methods: EETCA was surgically simulated, and the anatomical landmarks were assessed in eight cadaveric heads. Microsurgical dissections were additionally performed along the endoscopic surgical path. Lastly, we present an intraoperative video of the trans-JT approach in a patient with lower clival chordoma.

Results: The EETCA allowed adequate extracranial visualization and removal of the JT. The surgical bony window-obtained along the clivus and centered at the JT via the EETCA-measured 11 × 9 × 7 mm. Removal of the JT provided an improved intradural field within the lower third of the cerebellopontine cistern to expose an area bordered by the cranial nerves VII/VIII and flocculus superior and anterior margin of the lateral recess of the fourth ventricle and cranial nerves IX-XI inferiorly, centered on the foramen of Luschka.

Conclusions: Removal of the JT via EETCA improves exposure along the lower third of the cerebellopontine and upper cerebellomedullary cisterns. The inferolateral transtubercular extension of the EETCA provides access to the lateral recess of the fourth ventricle, in combination with the ventral midline pontomedullary region.
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http://dx.doi.org/10.1007/s00701-021-04835-xDOI Listing
April 2021

Glutamate Transporter 1 expression in human glioblastomas.

J BUON 2020 Jul-Aug;25(4):2051-2058

Aydin Adnan Menderes University, Faculty of Medicine, Department of Medical Biology, Aydin, Turkey.

Purpose: The purpose of our study was to investigate the mRNA expression profile of glutamate transporter 1 (GLT-1) in different types and grades of brain tumors, such as glioblastoma multiforme, astrocytomas (pilocytic, diffuse, anaplastic), oligodendrogliomas, ependydomas, medulloblastomas, and meningiomas using Real Time Quantitative PCR technique (qRT-PCR).

Methods: A total of 66 surgically removed primary brain tumors were collected retrospectively and the total RNA was isolated from each tumor sample. cDNA was generated and GLT-1 mRNA expression was evaluated with quantitative qRT-PCR.

Results: The mRNA expression of GLT-1 was significantly lower in primary brain tumors when compared to control brain tissues. GLT-1 expression was inversely correlated with the tumor grade, implicating its potential role in tumor progression. GLT-1 mRNA expression was lowest in grade 4 tumors, such as glioblastoma multiforme and medulloblastomas. The tumors with grade 3 and 4 combined displayed lower expression compared to tumors with grades 1 and 2. In grade 4 tumors, female patients displayed lower GLT-1 expression compared to male patients. In addition, glioblastoma multiforme patients older than 65 years of age showed lower GLT-1 expression when compared to the patients younger than 65.

Conclusion: qRT-PCR was found to be a sensitive method in detecting GLT-1 expression in brain tumors. This study may lay the foundation for the future research about the excitotoxicity and brain tumors and GLT-1 might be a potential biomarker. Targeted therapies based on excitotoxic molecular pathways against gliomas should be designed to effectively combat these diseases.
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October 2020

Endoscopic endonasal transclival approach to the ventral brainstem: Radiologic, anatomic feasibility and nuances, surgical limitations and future directions.

J Clin Neurosci 2020 Mar 28;73:264-279. Epub 2020 Jan 28.

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

The endoscopic endonasal transclival approach (EETA) is less invasive than traditional open approaches; however, there is currently limited data on the pre-operative features that may predict success of the EETA. Surgical landmarks and exposure of the EETA and expanded EETA are assessed. We retrospectively measured multiple anatomic features in 154 adult dry skulls, 22 C1 and C2 dry bone vertebrae, and 500 paranasal sinus computed tomography (CT) scans. We also dissected 13 formalin-fixed, silicone-injected adult cadaveric heads. Relevant qualitative and quantitative data were obtained with CT (n = 10) and cadaveric dissection (n = 13). They are expressed as mean (SD), as appropriate and compared with unpaired t tests. Categorical variables were compared with χ tests. We determined the prevalence of clival and sphenoid sinus anatomic variations and assessed potential exposure of the craniovertebral region, based on the relative position of the nasal bone tip, posterior point of the hard palate, and their relation to the position of C1 and C2. Depending on anatomic features, EETA should allow visualization of the ventral brainstem. The mean (SD) dimensions of the surgical window for EETA were 43.2 (5.1) × 18.3 (1.1) mm, in the craniocaudad and horizontal dimensions, respectively. The craniocaudad dimension enlarged to 60.2 (4.7) mm with expanded EETA. The EETA allowed satisfactory exposure for odontoid and C1 anterior arch resection (expanded EETA) in all specimens, regardless of the orientation of the palate. The combination of preoperative radiographic assessment and intraoperative considerations allows safe and effective application and facilitate selection of the most appropriate approach.
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http://dx.doi.org/10.1016/j.jocn.2020.01.012DOI Listing
March 2020

Anal Extrusion of a Ventriculoperitoneal Shunt.

J Coll Physicians Surg Pak 2019 May;29(5):478-480

Department of Neurosurgery, Tepecik Research and Training Hospital, University of Health Sciences, Izmir, Turkey.

Ventriculoperitoneal shunt (VPS) placement is an effective and most frequently used surgical method in the treatment of hydrocephalus, but the mechanical and infective complications are often seen after this surgical procedure. Bowel perforation after VPS surgery is rarely seen complication that is reported ranging between 0.1% and 0.7% in the literature. We report a case of 10-month baby who was shunted at day three of her life and has presented to us with protruding distal end of the ventricular catheter through anus. Mechanism of migration of VPS is unclarified yet; nevertheless, children with myelomeningocele have weakness of the bowel muscles, which probably makes it more sensitive for perforation. Additionally, sharp and stiff end of the VPS, use of trocar by some surgeons, chronic irritation by the shunt, previous surgery, infection and silicone allergy are other possible reasons of bowel perforation. Peritonitis and ventriculitis have a high morbidity and mortality that may occur after VPS-related bowel perforations; hence, it should be managed rapidly and aggressively to reduce morbidity and mortality.
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http://dx.doi.org/10.29271/jcpsp.2019.05.478DOI Listing
May 2019

Klippel-Trenaunay-Weber Syndrome with Atypical Presentation of Cerebral Cavernous Angioma: A Case Report and Literature Review.

World Neurosurg 2019 Jun 21;126:354-358. Epub 2019 Mar 21.

Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA; Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA.

Background: Klippel-Trenaunay-Weber syndrome (KTWS) is a rare syndrome characterized by the triad of cutaneous hemangiomas, venous varicosities, and osseous-soft tissue hypertrophy of the affected limb. Clinical manifestations, genetic testing, and radiologic imaging are the key steps in diagnosing this syndrome.

Case Description: An 18-month-old boy was brought for follow-up brain magnetic resonance imaging (MRI) with a history of right lower limb hypertrophy, cutaneous varicosities, and hemangiomas diagnosed at birth. A baseline MRI at 12 months revealed multiple hemorrhagic lesions within the cerebrum, the largest in the right temporal lobe, which was treated surgically at the age of 18 months because of its rapid growth. This is the youngest patient with KTWS treated surgically for intracranial hemangiomas.

Conclusion: KTWS is a rare disease with a wide range of manifestations. Multisystemic evaluation of this group of patients should be performed to identify cavernous hemangiomas at the early stage of life and adequately treat them in the future. Treatment of KTWS patients with cavernous hemangiomas should not be different from the treatment of patients with any other hemangiomas, and surgical intervention should be considered on a case-to-case bases.
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http://dx.doi.org/10.1016/j.wneu.2019.03.132DOI Listing
June 2019

Does Decompressive Duraplasty Have a Neuroprotective Effect on Spinal Trauma?: An Experimental Study.

World Neurosurg 2019 Jun 26;126:e288-e294. Epub 2019 Feb 26.

Department of Neurosurgery, Tepecik Research and Training Hospital, University of Health Sciences, Izmir, Turkey.

Background: Spinal cord injury (SCI) may result in neuromotor, sensory, and autonomic function damages. Edema because of spinal cord trauma can reach serious dimensions. The aim of this study was to histologically evaluate the effects of duraplasty on neural tissues.

Methods: Twenty-eight Wistar rats were randomly divided into 4 experimental groups: group 1 received laminectomy without SCI (sham); group 2 received laminectomy and SCI with the weight drop method; group 3 received laminectomy, SCI, and duraplasty within the first 6-8 hours of SCI; and group 4 received laminectomy, SCI, and duraplasty after 24 hours of SCI. The neurologic functions of the rats were tested periodically. All animals were euthanized 28 days after the surgery. Histopathologic and immunohistochemical evaluations were performed, and Kruskal-Wallis tests were used for statistical comparison of data between the groups.

Results: There was no significant difference in the Tarlov examination scores from different time points between the groups. The number of neurons stained with nuclear factor kappa beta was higher in group 3 than groups 1 and 4. The number of neurons stained with terminal deoxynucleotidyl transferase dUTP nick-end labeling was higher in group 2 than group 3.

Conclusions: Decompressive laminectomy is a procedure frequently used in spinal trauma surgery. However, it is often unclear whether the decompression is fully adequate. Our results will aid the development of further studies regarding the reliability of duraplasty in the treatment of SCI.
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http://dx.doi.org/10.1016/j.wneu.2019.02.043DOI Listing
June 2019

Hypoxia-Inducible Factor 1α and AT-Rich Interactive Domain-Containing Protein 1A Expression in Pituitary Adenomas: Association with Pathological, Clinical, and Radiological Features.

World Neurosurg 2019 Jan 5;121:e716-e722. Epub 2018 Oct 5.

Department of Pathology, Tepecik Research and Training Hospital, University of Health Sciences, Izmir, Turkey.

Background: Hypoxia-inducible factor (HIF) plays a major role in tumorigenesis and cancer progression. In hypoxic conditions, HIF is upregulated and has been shown to activate multiple genes required for cells to adapt to hypoxia. AT-rich interactive domain-containing protein 1A (ARID1A), a SWI/SNF (switch/sucrose nonfermentable) chromatin remodeling gene has context-dependent tumor-suppressive and oncogenic roles in cancer. We assessed the correlations between the expression and mutations of HIF1A and ARID1A in histopathologically confirmed pituitary adenomas.

Methods: We performed a retrospective analysis of 71 patients who had undergone surgery for pituitary adenoma. Patient demographic, radiological, and histopathological features were correlated with HIF1A and ARID1A expression.

Results: Most cases were HIF1A positive (62%). No significant correlation was found between HIF1A expression and age, gender, tumor size, bone erosion, hemorrhage, or Ki-67 index. An inverse correlation was demonstrated between HIF1A and cavernous sinus invasion (P = 0.035). ARID1A loss was found in 28.2% of pituitary adenomas. No significant correlation was found between ARID1A and any of the assessed variables.

Conclusions: In our patient cohort, we found that most pituitary adenomas expressed HIF1A. To the best of our knowledge, we are the first to assess the presence of ARID1A loss in pituitary adenomas, which occurred in 28.2% of cases. No individual demographic, imaging, or histopathological feature was predictive of ARID1A. Likewise, with the exception of an increased incidence of cavernous sinus invasion, no correlation was found with HIF1A. Given the prognostic value of these markers in other malignancies, their frequency in pituitary adenomas warrants further exploration of their potential role in pituitary adenoma treatment and outcome.
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http://dx.doi.org/10.1016/j.wneu.2018.09.196DOI Listing
January 2019

Recurrent Osteoma Overlying a Methylmethacrylate Bone Cement Cranioplasty: A Rare Case.

J Coll Physicians Surg Pak 2018 Jun;28(6):S102-S103

Department of Neurosurgery, Saglik Bilimleri University, Tepecik Research and Training Hospital, Izmir, Turkey.

Osteomas are generally benign tumors of the skull that affect all age groups and are diagnosed in the fourth or fifth decade of life, and are rare in childhood. Surgical resection is curative and malignant transformation is very rare. A 12-yearboy who had undergone a craniotomy for resection of a parietal osteoma four years ago, followed by a cranioplasty with methylmethacrylate bone cement, presented to our clinic with an expanding mass overlying the cranioplasty. Upon reoperation, the mass was totally excised, and the parietal cranial defect was repaired using methylmethacrylate bone cement. On histologic examination, the mass was found to be a recurrent osteoma overlying the methylmethacrylate bone cement. In this report, we discuss the etiologies of recurrence of osteoma and treatment options of these rare cases. We believe that this recurrence resulted from contamination of the surgical area and cranioplasty materials with osteoma material. Extensive washing of the cranioplasty materials and perioperative area may prevent recurrence of such tumors.
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http://dx.doi.org/10.29271/jcpsp.2018.06.S102DOI Listing
June 2018

Surgical Management in Cervical Spondylotic Myelopathy Due to Alkaptonuria.

World Neurosurg 2018 May 3;113:308-311. Epub 2018 Mar 3.

Department of Neurosurgery, Saglik Bilimleri University, Tepecik Research and Training Hospital, Izmir, Turkey. Electronic address:

Background: Ochronotic arthropathy related to alkaptonuria is a rare condition. Cervical spine involvement with myelopathic features has been even more rarely described, particularly related to atlantoaxial instability. As such, little is known about the optimal surgical management in these patients.

Case Description: We described the first case, to our knowledge, of a patient with alkaptonuria and related cervical spondylotic myelopathy from pannus formation at the atlantoaxial joint. We describe our choices in surgical management of this rare condition in a patient with an excellent outcome.

Conclusion: Ochronotic cervical spondylotic myelopathy is a rare condition and may require additional considerations in surgical treatment compared to more common causes of cervical spondylotic myelopathy. In our case, we elected for decompression with posterior occipitocervical screw fixation and were able to achieve neurologic recovery with no complications, currently at 2-year follow-up.
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http://dx.doi.org/10.1016/j.wneu.2018.02.148DOI Listing
May 2018

A Rare History: an Intracranial Nail Present for Over a Half-Century.

Acta Medica (Hradec Kralove) 2017;60(3):124-126

Tepecik Research and Training Hospital, Department of Neurosurgery, Izmir, Turkey.

We present a rare case of a patient with a persistent headache for many years found to have an intracranial nail present for nearly 65 years. The nail was found entering approximately 1 cm from the midline on the left side, passing below the superior sagittal sinus, with the tip 1.5 mm right of the frontal horn of the lateral ventricle. Treatment strategies designed to optimize outcome for intracranial foreign bodies and possible complications are discussed in this report. We also discuss the decision for surgical intervention for foreign bodies and the relevance of position of the foreign body.
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http://dx.doi.org/10.14712/18059694.2018.5DOI Listing
April 2018

Neurological recovery after traumatic Cauda Equina syndrome due to glass fragments: An unusual case.

Ulus Travma Acil Cerrahi Derg 2018 Jan;24(1):82-84

Department of Neurosurgery, Health Sciences University, Tepecik Research and Training Hospital, İzmir-Turkey.

Penetrating spinal injuries with foreign bodies are exceedingly rare. To date, pathological problems due to glass fragments in the spinal canal have rarely been reported. In this report, the case presenting with a back laceration, leg pain, and leg weakness was found to have glass frag-ments in the spinal canal at the L2-L3 level by lumbar computed tomography and magnetic resonance imaging. After L2 total laminectomy and retrieval of the glass fragments, the dura was re-paired. The patient was discharged from the hospital after complete neurological recovery. In cases of spinal canal injuries due to foreign bodies, early operative decompression of the neural elements is the treatment of choice. Patients with Cauda Equina syndrome due to glass fragments have a good prognosis for functional recovery.
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http://dx.doi.org/10.5505/tjtes.2017.40583DOI Listing
January 2018

A Case of Pseudoaneurysm of the Internal Carotid Artery Following Endoscopic Endonasal Pituitary Surgery: Endovascular Treatment with Flow-Diverting Stent Implantation.

Acta Medica (Hradec Kralove) 2017;60(2):89-92

Department of Neurosurgery, Saglik Bilimleri University, Tepecik Research and Training Hospital, Izmir, Turkey.

Internal carotid artery (ICA) pseudoaneurysm is a rare complication of endoscopic endonasal surgery occurring in 0.4-1.1% of cases. Pseudoaneurysms can subsequently result in other complications, such as subarachnoid hemorrhage, epistaxis, and caroticocavernous fistula with resultant death or permanent neurologic deficit. In this case, we illustrate endovascular treatment with a flow-diverting stent for an ICA pseudoaneurysm after endoscopic endonasal surgery for a pituitary adenoma in a 56-year-old male. Surgery was complicated by excessive intraoperative bleeding and emergent CT angiography confirmed an iatrogenic pseudoaneurysm on the anteromedial surface of the ICA. The pseudoaneurysm was treated endovascularly with flow-diverting stent implantation only. Follow-up CT angiography after three months demonstrated occlusion of the pseudoaneurysm.
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http://dx.doi.org/10.14712/18059694.2017.100DOI Listing
June 2018

C1 lateral mass screw insertion from the caudal-dorsal to the cranial-ventral direction as an alternate method for C1 fixation: A quantitative anatomical and morphometric evaluation.

J Clin Neurosci 2017 Aug 15;42:176-181. Epub 2017 May 15.

Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address:

Object: C1 lateral mass screw has been widely used for fixation of the upper cervical spine. However, traditional fixation methods are not without complication. Morphometric measurement of an alternative approach is conducted.

Methods: Three-dimensional CT scans of the cervical spine obtained in 100 adults were evaluated, and key measurements were determined for screw entry points, trajectories, and screw lengths for placement of a C1 screw via this alternate approach. Additional measures were included to account for relevant anatomic variation, including the size of the dangerous lateral zone of the C1 entry point and depth of the atlantooccipital joint surface. Twenty dried atlantal specimens were evaluated to determine corresponding ex vivo measurements.

Results: The mean maximum angle of medialization was 20.8°±2.8° (right) and 21.1°±2.8° (left), as measured in the axial CT images. Sagittal CT images show the mean maximum superior angulation was 24.7°±4.3° (right) and 24°±4.0° (left), and the mean minimum superior angulation was 13.6°±4.4° (right) and 13.6°±3.9° (left). The mean screw length within the lateral mass was 21.2±1.9mm (right) and 21.3±2.0mm (left). Given an additional 10-15mm needed for rod adaptation, an ideal screw length of 30-35mm was determined.

Conclusion: The C1 insertion caudally from the C2 nerve root may become an alternate method. Preoperative consideration of the ideal screw insertion point, trajectory, and length are vital for safe and effective surgical intervention.
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http://dx.doi.org/10.1016/j.jocn.2017.04.041DOI Listing
August 2017

Cortical Bone Trajectory Screw for Lumbar Fixation: A Quantitative Anatomic and Morphometric Evaluation.

World Neurosurg 2017 Jul 3;103:694-701. Epub 2017 May 3.

Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA.

Background: Lumbar cortical bone trajectory (CBT) screw constructs provide an alternative method of pedicle screw fixation in minimally invasive spine surgery. In this study, we explored the CBT technique in further anatomic detail. The primary aims were to evaluate variations in anatomy relevant to CBT screw placement and to determine optimal screw location, trajectory, and length using measures obtained from computed tomography (CT) scans.

Methods: One hundred CT scans of the lumbar spine were reviewed, and 14 total measurements of entry points, trajectories, and lengths for placement of CBT screws were evaluated.

Results: Across all lumbar levels, the mean right pedicle-pars interarticularis junction length ranged from 7.58 ± 1.18 mm to 8.37 ± 1.42 mm, and the mean left pedicle-pars interarticularis junction length ranged from 7.95 ± 1.42 mm to 8.6 ± 1.74 mm. The pedicle-pars interarticularis junction from L1 to L5 was deemed too small for a 5-mm-diameter CBT screw in 35%, 24%, 17%, 17%, and 19%, respectively, on the right, and in 30%, 17%, 17%, 17%, and 20%, respectively, on the left. The average length of a screw placed along the cranial cortical bone of the pedicle ranged from 27 ± 2.5 mm to 30.5 ± 3.4 mm, and the angle of the screw with respect to the vertebral body endplate ranged from 44 ± 4.1° to 48 ± 6.2°.

Conclusions: Improved anatomic knowledge relevant to CBT screw placement for lumbar fixation offers the potential for improving outcomes and reducing complications. Moreover, detailed analysis of the anatomy of the pedicle-pars interarticularis junction via preoperative CT can aid in determining the ideal fixation method.
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http://dx.doi.org/10.1016/j.wneu.2017.03.137DOI Listing
July 2017

Intraoperative squash cytology and histology of giant cell ependymoma: A diagnostic dilemma.

J Cytol 2017 Jan-Mar;34(1):63-65

Department of Pathology, Izmir Tepecik Education and Research Hospital, Izmir, Turkey.

Giant cell ependymomas (GCE) are extremely rare tumors, with 24 cases described in the literature. Squash cytology is a rapid, reliable, simple technique for intraoperative consultation in neurosurgical practice. We describe a rare case of GCE arising at level of L4-L5 in a 66-year-old woman and discuss the cytologic/histologic features. Intraoperative smears were highly cellular with a prominent fibrillary background and exhibited papillary structures and sheets composed of highly atypical and bizarre cells. Some of the cells showed nuclear pseudoinclusions and rarely formed pseudorosette-like arrays. Intraoperative diagnosis was high grade glial tumor. On paraffin sections, besides extensive polymorphism, there were no microvascular proliferation, necrosis, and mitosis and the final diagnosis was WHO grade II GCE. GCE may be a diagnostic challenge on intraoperative smears, frozen, and paraffin sections. It must be kept in mind in the differential diagnosis of giant cell exhibiting benign and malignant tumors of brain.
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http://dx.doi.org/10.4103/0970-9371.197625DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5259938PMC
February 2017

Oxidative/Nitrosative Stress in Patients With Modic Changes: Preliminary Controlled Study.

Spine (Phila Pa 1976) 2015 Jul;40(14):1101-7

Departments of *Biochemistry, and †Brain and Nerve Surgery, Faculty of Medicine, Sutcu Imam University, Kahramanmaras, Turkey.

Study Design: Oxidative/nitrosative stress in vertebral endplates of patients with low back pain and Modic changes (MCs) (types I, II, and III) endplate changes on magnetic resonance imaging.

Objective: The aim of this study was to assess the levels of oxidative/nitrosative stress biomarkers in patients with MCs.

Summary Of Background Data: Degenerated discs and endplate abnormalities is postulated as a possible source of low back pain. Oxidative/nitrosative stress plays an important the role in various human diseases. However, the presence of oxidative/nitrosative stress has not been studied in patients with low back pain and endplate changes on magnetic resonance imaging.

Methods: Patients with MCI, II, and III (n = 32) and age- and sex-matched controls subjects (n = 15) were enrolled in this study. Also, 3-nitrotyrosine (3-NT) and nitric oxide levels as nitrosative stress biomarkers were measured with enzyme-linked immunosorbent assay. Also, the activities of catalase (CAT) and superoxide dismutase (SOD), and the levels of malondialdehyde (MDA) as oxidative stress biomarkers were determined on spectrophotometer.

Results: Oxidative/nitrosative stress was confirmed by the significant elevation in nitric oxide, 3-NT, MDA and decreased of CAT and SOD activities in MCI compared with other MCs and the control group (P < 0.05). The highest CAT and SOD activities were found in patients with MCII compared with the other MCs and the control group. However, the levels of nitric oxide, 3-NT, and MDA showed moderate increase in this group (P < 0.05). In addition, the levels of nitrosative stress biomarkers in patients with MCIII were approximated to the control values (P > 0.05). However, the levels of oxidative stress biomarkers in patients with MCIII were slightly higher than that of the control group (P < 0.05).

Conclusion: Our findings indicated that oxidative/nitrosative stress in patients with MCI may be aggravated as a result of oxidant/antioxidant imbalance and it may cause formation of the lesion in these patients. However, the increased antioxidant activities and MDA, 3-NT levels in patients with MCII and MCIII may be an adaptative response to against oxidative/nitrosative stress.

Level Of Evidence: 4.
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http://dx.doi.org/10.1097/BRS.0000000000000737DOI Listing
July 2015

Spinal dural arteriovenous malformation presented with intracranial hypertension in a young patient.

BMJ Case Rep 2012 Dec 14;2012. Epub 2012 Dec 14.

Department of Radiology, Sütçü İmam University, Kahramanmaraş, Turkey.

Spinal dural arteriovenous malformations (AVM), the most common type of spinal cord vascular malformation, can be a challenge to diagnosis and prompt treatment. The disorder is rare, and the presenting clinical symptoms and signs are non-specific and insidious at onset. Spinal dural AVMs preferentially affect middle-aged men, and patients most commonly present with gait abnormality or lower-extremity weakness and sensory disturbances. İt may rarely present with symptoms of intracranial hypertension including headache and visual disorders. In this report, we present the radiological findings of a 19-year-old male patient with spinal dural AVM presenting with raised intracranial pressure symptoms including papilloedema and headache, and discuss with recent literature.
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http://dx.doi.org/10.1136/bcr-2012-007906DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4545041PMC
December 2012

Cerebral venous sinus thrombosis associated with spontaneous intermittent cerebrospinal fluid rhinorrhea: a case report.

Med Princ Pract 2012 6;21(4):392-4. Epub 2012 Apr 6.

Department of Neurology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey.

Objectives: To present a rare case of cerebral venous sinus thrombosis (CVST).

Clinical Presentation And Intervention: A 43-year-old woman presented with coma and was diagnosed as a case of CVST. She recovered in a few days with heparin treatment. Many possible risk factors for CSVT were negative in the patient but intermittent cerebrospinal fluid (CSF) rhinorrhea was accidentally noticed. Cerebral computed tomography and magnetic resonance imaging were done. The patient was diagnosed as having spontaneous intermittent CSF rhinorrhea due to a defect in the base of the skull.

Conclusions: This case showed the importance of being aware that a defect in the base of the skull may lead to intermittent CSF rhinorrhea in patients with CVST.
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http://dx.doi.org/10.1159/000336782DOI Listing
October 2012

Placement of C-7 intralaminar screws: a quantitative anatomical and morphometric evaluation.

J Neurosurg Spine 2012 May 17;16(5):509-12. Epub 2012 Feb 17.

Departments of Neurosurgery, Kahramanmaraş Sütçüimam Universitesi School of Medicine, Kahramanmaraş, Turkey.

Object: Crossing laminar screws at C-7 have been recently described as a method for the fixation of C-7. In this study the authors measured locations on axial CT scans to determine the feasibility of placing a screw in the C-7 lamina, and they evaluated the reliability of the surface of the dorsal arch of C-7 as a landmark for determining the optimal site of screw entry.

Methods: A total of 207 axial CT scans of C-7 spines were evaluated, and 4 critical measurements were determined for screw entry points, trajectories, and lengths for placement of intralaminar screws.

Results: The mean width of the right C-7 lamina was 5.9 mm (range 4.2-9.3 mm). The mean width of the left C-7 lamina was 6.0 mm (range 4.2-10.2 mm). The laminar width was too small (< 5.5 mm) in 37.7% of cases to accommodate a 3.5-mm diameter screw, given the desire for at least 1 mm of play on each side of the screw.

Conclusions: These measurements provide guidelines for operating on the posterior aspect of C-7 and enhance the confidence of the surgeon. Viewing the anatomy of the C-7 laminae in detail through preoperative CT scanning can greatly assist the surgeon in choosing the fixation method. The width of the C-7 lamina is sufficient for intralaminar screw placement in more than 60% of patients.
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http://dx.doi.org/10.3171/2012.1.SPINE111048DOI Listing
May 2012

Morphologic evaluation of cervical and lumbar facet joints: intra-articular facet block considerations.

Pain Pract 2010 Jul-Aug;10(4):272-8. Epub 2010 Mar 2.

Department of Anesthesiology, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey.

Study Design: Needle orientations for lumbar and cervical facet injection were measured in cadavers and compared with facet angles measured on magnetic resonance images (MRIs).

Objectives: To establish facet orientation relative to clinical procedures of a facet joint block in the cervical and lumbar spine.

Methods: Needle orientation angles were measured from 20 unembalmed human cadaveric specimens (13 cervical and 7 lumbar). Spinal needles were inserted into the midpoints of the facet joint spaces from C3 to C7 and L1 to L5. Needle trajectories were measured with an optical tracking system. For comparison, facet angles from 100 clinical MRIs of lumbar spines were also measured. Facet orientations on MRIs were measured at their intersection with the transverse plane, and angles were quantified using image analysis software.

Results: Typical angles for insertion of the needle into the cervical facets were oriented closer to the coronal plane, whereas insertion angles for lumbar needles were oriented closer to the sagittal plane. Relative to the sagittal plane, the mean cervical angle was 72 degrees and the mean lumbar angle was 33 degrees. The insertion points of the cervical facets were a mean of 29 mm from the midsagittal plane compared with a mean of 22 mm for the lumbar facets. MRI-based facet joint angles correlated poorly with actual injection angles, which were overestimated 5 to 23 degrees, depending on the lumbar level.

Conclusions: Knowledge of the quantitative anatomy of the facets may help improve clinical diagnosis and treatment. These data also may aid in constructing more realistic computer simulations.
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http://dx.doi.org/10.1111/j.1533-2500.2010.00365.xDOI Listing
October 2010

Feasible and accurate occipitoatlantal transarticular fixation: an anatomic study.

Neurosurgery 2010 Mar;66(3 Suppl Operative):173-7; discussion 177

Department of Neurosurgery, School of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey.

Background: Defining the anatomic zones for the placement of occiput-C1 transarticular screws is essential for patient safety.

Objective: The feasibility and accuracy of occiput-C1 transarticular screw placement were evaluated in this anatomical study of normal cadaveric specimens.

Material And Methods: Sixteen measurements were determined for screw entry points, trajectories, and lengths for placement of transarticular screws, as applied in the technique described by Grob, on the craniovertebral junction segments (occiput-C2) of 16 fresh human cadaveric cervical spines and 41 computed tomographic reconstructions of the craniovertebral junction. Acceptable angles for screw positioning were measured on digital x-rays.

Results: All 32 screws were placed accurately. As determined by dissection of the specimens, none of the screws penetrated the spinal canal. Screw insertion caused no fractures, and the integrity of the hypoglossal canal was maintained in all the disarticulated specimens.

Conclusion: Viable transarticular occiput-C1 screw placement is possible, despite variability of the anatomy of the occipital condyle.
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http://dx.doi.org/10.1227/01.NEU.0000350982.03929.05DOI Listing
March 2010

Dynamic lumbar pedicle screw-rod stabilization: in vitro biomechanical comparison with standard rigid pedicle screw-rod stabilization.

J Neurosurg Spine 2010 Feb;12(2):183-9

Department of Neurosurgery, VKV Amerikan Hastanesi, Istanbul, Turkey.

Object: It is unclear how the biomechanics of dynamic posterior lumbar stabilization systems and traditional rigid pedicle screw-rod systems differ. This study examined the biomechanical response of a hinged-dynamic pedicle screw compared with a standard rigid screw used in a 1-level pedicle screw-rod construct.

Methods: Unembalmed human cadaveric L3-S1 segments were tested intact, after L4-5 discectomy, after rigid pedicle screw-rod fixation, and after dynamic pedicle screw-rod fixation. Specimens were loaded using pure moments to induce flexion, extension, lateral bending, and axial rotation while recording motion optoelectronically. Specimens were then loaded in physiological flexion-extension while applying 400 N of compression. Moment and force across instrumentation were recorded from pairs of strain gauges mounted on the interconnecting rods.

Results: The hinged-dynamic screws allowed an average of 160% greater range of motion during flexion, extension, lateral bending, and axial rotation than standard rigid screws (p < 0.03) but 30% less motion than normal. When using standard screws, bending moments and axial loads on the rods were greater than the bending moments and axial loads on the rods when using dynamic screws during most loading modes (p < 0.05). The axis of rotation shifted significantly posteriorly more than 10 mm from its normal position with both devices.

Conclusions: In a 1-level pedicle screw-rod construct, hinged-dynamic screws allowed a quantity of motion that was substantially closer to normal motion than that allowed by rigid pedicle screws. Both systems altered kinematics similarly. Less load was borne by the hinged screw construct, indicating that the hinged-dynamic screws allow less stress shielding than standard rigid screws.
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http://dx.doi.org/10.3171/2009.9.SPINE0951DOI Listing
February 2010

Intraperitoneal Alpha-Lipoic Acid to prevent neural damage after crush injury to the rat sciatic nerve.

J Brachial Plex Peripher Nerve Inj 2009 Nov 25;4:22. Epub 2009 Nov 25.

Department of Neurosurgery, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey.

Objective: Crush injury to the sciatic nerve causes oxidative stress. Alfa Lipoic acid (a-LA) is a neuroprotective metabolic antioxidant. This study was designed to investigate the antioxidant effects of pretreatment with a-LA on the crush injury of rat sciatic nerve.

Methods: Forty rats were randomized into four groups. Group I and Group II received saline (2 ml, intraperitoneally) and a-LA (100 mg/kg, 2 ml, intraperitoneally) in the groups III and IV at the 24 and 1 hour prior to the crush injury. In groups II, III and IV, the left sciatic nerve was exposed and compressed for 60 seconds with a jeweler's forceps. In Group I (n = 10), the sciatic nerve was explored but not crushed. In all groups of rats, superoxide dismutase (SOD) and catalase (CAT) activities, as well as malondialdehyde (MDA) levels were measured in samples of sciatic nerve tissue.

Results: Compared to Group I, Group II had significantly decreased tissue SOD and CAT activities and elevated MDA levels indicating crush injury (p < 0.05). In the a-LA treatment groups (groups III and IV), tissue CAT and SOD activities were significantly increased and MDA levels significantly decreased at the first hour (p < 0.05) and on the 3rd day (p < 0.05). There was no significant difference between a-LA treatment groups (p > 0.05).

Conclusion: A-LA administered before crush injury of the sciatic nerve showed significant protective effects against crush injury by decreasing the oxidative stress. A-LA should be considered in the treatment of peripheral nerve injuries, but further studies are needed to explain the mechanism of its neuroprotective effects.
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http://dx.doi.org/10.1186/1749-7221-4-22DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2789059PMC
November 2009

Combined anterior and posterior approach for sacral/retroperitoneal hydatid cyst disease: case report.

Turk Neurosurg 2009 Oct;19(4):428-32

Kahramanmaraş Sütcü Imam University, Medical Faculty, Neurosurgery Department, Kahramanmaras, Turkey.

Achieving complete resolution of spinal hydatid cyst disease is quite challenging when bone is involved. Many authors reported the poor outcome of posterior decompression and laminectomy for intraosseous spinal hydatid disease. In an attempt to avoid a similar poor outcome, hydatid cysts were reached via both anterior and posterior surgical approaches in our patient. A 73-year-old man presented with complaints of low back and right leg pain. Symptoms or signs of systemic hydatid cyst disease were absent. MRI demonstrated a cystic lesion in the presacral/retroperitoneal region, involving the body of the sacrum and sacral canal. Computed tomography images showed enlargement of the sacral foraminae. The multiseptated cysts and their contents were isodense with cerebrospinal fluid. The cysts were removed via an anterior extraperitoneal approach, using a paramedian vertical incision, and then were also approached posteriorly via bilateral S1 hemilaminectomy. No neurological deficits occurred following surgery. The patient's symptoms completely disappeared after this combination of aggressive surgery and antihelminthic therapy. The application of both anterior and posterior approaches to intraosseous sacral hydatid cysts may be preferred when faced with hydatid disease in this location.
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October 2009

Biomechanical effects of laminoplasty versus laminectomy: stenosis and stability.

Spine (Phila Pa 1976) 2009 Jul;34(16):E573-8

Department of Neurosurgery Research, Spinal Biomechanics Laboratory, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA.

Study Design: In vitro human cadaveric study simultaneously quantifying sagittal plane flexibility and spinal canal stenosis.

Objective: To compare biomechanical stability and the change in cross-sectional area during flexion and extension after laminectomy and open-door laminoplasty.

Summary Of Background Data: Spinal canal stenosis has been quantified in vitro but has not been quantified in studies of laminectomy or laminoplasty.

Methods: Cadaveric specimens were loaded in physiologic-range flexion and extension using nonconstraining pure moments while recording segmental angles optoelectronically. Custom flexible tubing was placed within the spinal canal, and water was continuously pumped through the tubing while measuring upstream pressure. Spinal canal cross-sectional area correlated to water pressure, allowing continuous monitoring of the smallest cross-sectional area of the canal. Specimens were tested (1) normal, (2) after modeling stenosis by inserting hemispherical wooden beads in the spinal canal at 3 levels, (3) after open-door laminoplasty at 5 levels, and (4) after expanding laminoplasty to laminectomy.

Results: Range of motion (ROM) in the normal, stenotic, and laminoplasty conditions did not differ significantly. However, laminectomy increased ROM significantly more than other conditions. ROM after laminectomy was 13% greater than after laminoplasty. After modeling stenosis, the cross-sectional area decreased to 52% +/- 12% of normal. Laminoplasty restored the cross-sectional area to 70% +/- 12% of normal whereas laminectomy restored cross-sectional area to 101% +/- 4% of normal. Among all conditions, areas differed significantly except normal versus laminectomy.

Conclusion: Laminoplasty leaves the spine in a significantly more stable condition than laminectomy. However, laminoplasty failed to relieve stenosis completely. In this study, stenosis was modeled as about 50% occlusion of the spinal canal. The degree of stenosis should be considered in clinical decisions of whether laminectomy or laminoplasty is more appropriate.
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http://dx.doi.org/10.1097/BRS.0b013e3181aa0214DOI Listing
July 2009

Biomechanics of C-7 transfacet screw fixation.

J Neurosurg Spine 2009 Sep;11(3):338-43

Department of Neurological Surgery, Indiana University College of Medicine, Indianapolis, Indiana, USA.

Object: The small diameter of the pedicle can make C-7 pedicle screw insertion dangerous. Although transfacet screws have been studied biomechanically when used in pinning joints, they have not been well studied when used as part of a C7-T1 screw/rod construct. The authors therefore compared C7-T1 fixation using a C-7 transfacet screw/T-1 pedicle screw construct with a construct composed of pedicle screws at both levels.

Methods: Each rigid posterior screw/rod construct was placed in 7 human cadaveric C6-T2 specimens (14 total). Specimens were tested in normal condition, after 2-column instability, and once fixated. Nondestructive, nonconstraining pure moments (maximum 1.5 Nm) were applied to induce flexion, extension, lateral bending, and axial rotation while recording 3D motion optoelectronically. The entire construct was then loaded to failure by dorsal linear force.

Results: There was no significant difference in angular range of motion between the 2 instrumented groups during any loading mode (p > 0.11, nonpaired t-tests). Both constructs reduced motion to < 2 degrees in any direction and allowed significantly less motion than in the normal condition. The C-7 facet screw/T-1 pedicle screw construct allowed a small but significantly greater lax zone than the pedicle screw/rod construct during lateral bending, and it failed under significantly less load than the pedicle screw/rod construct (p < 0.001).

Conclusions: When C-7 transfacet screws are connected to T-1 pedicle screws, they provide equivalent stability of constructs formed by pedicle screws at both levels. Although less resistant to failure, the transfacet screw construct should be a viable alternative in patients with healthy bone.
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http://dx.doi.org/10.3171/2009.3.SPINE08785DOI Listing
September 2009

C2 intralaminar screw placement: a quantitative anatomical and morphometric evaluation.

Turk Neurosurg 2009 Jul;19(3):245-8

Kahramanmaras Sutcu Imam University Faculty of Medicine, Neurosurgery Department, Kahramanmaras, Turkey.

Aim: To investigate the feasibility of placing a screw in the C2 lamina and evaluate the reliability of the surface of the dorsal arch of C2 as a landmark for determining the optimal site of screw entry.

Material And Methods: 88 adult human C2 spines were used. Seven measurements were determined for screw entry points, trajectories, and lengths for placement of intralaminar screws.

Results: The average width of right C2 lamina (1/3 upper segment) was 2.6 mm (1.2 to 4.1 mm). The average width of left C2 lamina (1/3 upper segment) was 2.6 mm (1 to 4 mm). The average width of right C2 lamina (1/3 middle segment) was 4.9 mm (2.6 to 6.8 mm). The average width of left C2 lamina (1/3 middle segment) was 4.9 mm (2.3 to 7.6 mm). The average width of right C2 lamina (1/3 lower segment) was 5.7 mm (3.3 to 8.2 mm). The average width of left C2 lamina (1/3 lower segment) was 5.8 mm (2.2 to 9.6 mm).

Conclusion: The width of the upper one-third of C2 lamina is not appropriate for the placement of intralaminar screws. On the other hand, the width of the middle and lower one-third of C2 lamina is more convenient for intralaminar screw delivery.
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July 2009

Nonvestibular schwannomas: an evaluation of functional outcome after radiosurgical and microsurgical management.

Acta Neurochir (Wien) 2010 Jan 5;152(1):35-46. Epub 2009 Jun 5.

Department of Neurosurgery, University of Oklahoma, Oklahoma City, OK, USA.

Purpose: Nonvestibular cranial nerve schwannomas (NVCNS) are relatively rare tumors. We evaluated our experience with radiosurgical and microsurgical treatment alone and in combination for the management of NVCNS.

Methods: The charts of 62 patients with NVCNS who were treated between 1993 and 2005 at our institution were reviewed. Patients diagnosed with neurofibromatosis type 2 were excluded. The patients underwent microsurgery and/or radiosurgery treatment.

Results: Trigeminal and jugular foramen schwannomas were the most common NVCNS tumors (n = 47), and the only two groups with sufficient numbers of patients to allow comparison of the three treatment approaches. In these two groups, the mean tumor volume was significantly higher in those who received combined therapy (8.59 +/- 2.29 cc), compared with radiosurgery (4.94 +/- 3.02 cc; p = 0.05) or microsurgery alone (5.38 +/- 3.23; p = 0.027). Patients who underwent radiosurgery alone were significantly older (67.7 +/- 13.3 years; p = 0.019) than those treated with microsurgery (55.3 +/- 13.7 years) or with both modalities (48.7 +/- 12.8 years). The Karnofsky Performance Scale scores were significantly higher (p < or = 0.05) at follow-up compared with baseline for all three treatment approaches. There was no significant change in the Glasgow Outcome scores before and after treatment.

Conclusions: Microsurgery and radiosurgery can both be used to manage NVCNS tumors with excellent results. When treatment with either modality alone is not reasonable, tumors can be managed effectively with combined micro- and radiosurgery treatment.
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http://dx.doi.org/10.1007/s00701-009-0403-5DOI Listing
January 2010

Microsurgical management of spinal schwannomas: evaluation of 128 cases.

J Neurosurg Spine 2008 Jul;9(1):40-7

Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.

Object: The authors conducted a study to evaluate the clinical characteristics and surgical outcomes in patients with spinal schwannomas and without neurofibromatosis (NF).

Methods: The data obtained in 128 patients who underwent resection of spinal schwannomas were analyzed. All cases with neurofibromas and those with a known diagnosis of NF Type 1 or 2 were excluded. Karnofsky Performance Scale (KPS) scores were used to compare patient outcomes when examining the anatomical location and spinal level of the tumor. The neurological outcome was further assessed using the Medical Research Council (MRC) muscle testing scale.

Results: Altogether, 131 schwannomas were treated in 128 patients (76 males and 52 females; mean age 47.7 years). The peak prevalence is seen between the 3rd and 6th decades. Pain was the most common presenting symptom. Gross-total resection was achieved in 127 (97.0%) of the 131 lesions. The nerve root had to be sacrificed in 34 cases and resulted in minor sensory deficits in 16 patients (12.5%) and slight motor weakness (MRC Grade 3/5) in 3 (2.3%). The KPS scores and MRC grades were significantly higher at the time of last follow-up in all patient groups (p = 0.001 and p = 0.005, respectively).

Conclusions: Spinal schwannomas may occur at any level of the spinal axis and are most commonly intradural. The most frequent clinical presentation is pain. Most spinal schwannomas in non-NF cases can be resected totally without or with minor postoperative deficits. Preoperative autonomic dysfunction does not improve significantly after surgical management.
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http://dx.doi.org/10.3171/SPI/2008/9/7/040DOI Listing
July 2008