Publications by authors named "Murat Hanci"

23 Publications

  • Page 1 of 1

Comparison of two surgical techniques in Chiari Malformation Type 1 Patients: Duraplasty alone vs duraplasty with arachnoid dissection.

Clin Neurol Neurosurg 2021 Jul 15;206:106686. Epub 2021 May 15.

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

Object: Optimal surgical technique to restore the cerebrospinal fluid flow through the foramen magnum remains to be debated in Chiari malformation type 1 (CM-1) patients.

Method: This study included 46 patients with CM-1 who underwent surgical treatment by one of two methods: posterior fossa bone decompression (BD) with arachnoid preserving duraplasty (Group 1) and BD with duraplasty and arachnoid dissection (Group 2). Complaints of the patient population and neurological findings were assessed with Neck Disability Index (NDI) and Europe Quality of Life 5 Dimensions (EQ-5D) in pre- and postoperative periods.

Results: NDI and EQ-5D scores improved in overall patient population and in each individual surgical group. Both groups showed a significant decrease in size of syringomyelia cavity. Complications resulting in recurrent treatments and re-operations occurred in 15% of patients (n = 7); six of them were from Group 2.

Conclusion: CM-1 patients benefit significantly from surgical treatment. Duraplasty should be included to surgical technique. Avoiding arachnoid dissection may lead to better results regarding complication rates.
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http://dx.doi.org/10.1016/j.clineuro.2021.106686DOI Listing
July 2021

Intramedullary tumors, surgical approaches and outcomes.

Authors:
Murat Hanci

J Clin Neurosci 2021 Mar 29. Epub 2021 Mar 29.

Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey. Electronic address:

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http://dx.doi.org/10.1016/j.jocn.2021.03.011DOI Listing
March 2021

Comparative Analysis of NF-κB in the MyD88-Mediated Pathway After Implantation of Titanium Alloy and Stainless Steel and the Role of Regulatory T Cells.

World Neurosurg 2020 12 8;144:e138-e148. Epub 2020 Aug 8.

Faculty of Science, School of Life Sciences, University of Technology Sydney, Sydney, Australia.

Objective: Development of immunologically smart implants, integrated to biological systems, is a key aim to minimize the inflammatory response of the host to biomaterial implants.

Methods: The aim of this study is to investigate the influence of titanium alloy and stainless steel implants on immunological responses in rats by comparative analysis of nuclear factor kappa B (NF-κB) profiles in the activation of inflammatory signaling pathways and the role of CD4+CD25+Foxp3+.

Results: Both Ti alloy and stainless steel alloy group implantation affect Toll-like receptors-4 pathways and CD4+CD25+ regulatory T cells in different ways.

Conclusions: Results show that NF-κB/p65 and NF-κB1/p50 possess potential as a therapeutic target in the prevention of adverse reactions to metal, especially for controlling inflammation after the implantation.
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http://dx.doi.org/10.1016/j.wneu.2020.08.016DOI Listing
December 2020

Neurophysiological Monitoring in Spinal Dural Arteriovenous Fistula Surgery at the Thoracic Spine: A Case Report.

Neurol India 2019 Nov-Dec;67(6):1556-1558

Department of Neurosurgery, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey.

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http://dx.doi.org/10.4103/0028-3886.273640DOI Listing
August 2020

Intraoperative Neuromonitoring in Surgery of Cauda Equina and Conus Medullaris Tumors.

Turk Neurosurg 2019 ;29(6):909-914

Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Neurology, Istanbul, Turkey.

Aim: To demonstrate the value of special intraoperative neuromonitoring techniques for cauda equina and conus medullaris tumors (CECMT) by describing standard methods used at our center.

Material And Methods: Neurophysiological records were retrospectively reviewed for 16 patients (eight females and eight males; age range: 27â€"60 years) who underwent surgery for CECMT at our department between 2016 and 2018.

Results: Motor and/or sensorial deficits were preoperatively identified in 10 patients; no patients had bladder or sexual dysfunction. Motor evoked potential (MEP) loss occurred in seven patients with full or partial recovery. No changes were seen in pudendal somatosensory evoked potential (SEP) or bulbocavernosus reflex (BCR), and morphological deterioration and amplitude loss of tibial SEPs were present in four patients. Postoperatively, no new neurological deficits and/or bladder and sexual dysfunction were present.

Conclusion: Pudendal SEP and BCR are useful tests for monitoring CECMT surgeries. BCR is an easily obtainable modality for preserving sacral functions and recommended as a primary monitoring modality in conjunction with traditional neurophysiological techniques during CECMT surgery.
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http://dx.doi.org/10.5137/1019-5149.JTN.26479-19.2DOI Listing
February 2020

Spinal Vascular Malformations: Treatment and Outcome.

World Neurosurg 2019 Oct 11;130:e953-e960. Epub 2019 Jul 11.

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

Background: Vascular malformations of the spinal cord are a rare and complex clinical entity and can lead to severe morbidity with progressive spinal cord symptoms if not treated properly. In early stages, the disease is characterized by slowly progressive, nonspecific symptoms, such as gait disturbance, paresthesia, diffuse sensory symptoms, and radicular pain; in the late stages, bowel and bladder incontinence, erectile dysfunction, and urinary retention may develop. In recent decades, understanding and treatment of spinal vascular malformations have improved with the evolution of diagnostic tools and treatment modalities; however, it is still difficult to manage these cases because of the complexity of the pathology. The aims of this study were to present the long-term outcomes of our patients and to discuss the optimal management strategies.

Methods: We reviewed the records of 78 patients with spinal vascular malformations and performed a retrospective, single-center case series evaluating initial occlusion, recanalization, retreatment, and neurologic status of patients with dural arteriovenous fistulas, perimedullary arteriovenous fistulas, arteriovenous malformations, and extradural arteriovenous fistulas who had undergone embolization and/or surgery.

Results: No mortality was observed. Complete obliteration was achieved in 76 patients (97.4%).

Conclusions: Both endovascular and surgical treatment of spinal vascular malformations resulted in significant long-term recovery from myelopathic symptoms and improvement in quality of life for most patients.
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http://dx.doi.org/10.1016/j.wneu.2019.07.043DOI Listing
October 2019

Posturographic examination of body balance in patients with Chiari type I malformation and correlation with the presence of syringomyelia and degree of cerebellar ectopia.

Turk J Phys Med Rehabil 2019 Mar 11;65(1):74-79. Epub 2018 Mar 11.

Department of Physical Medicine and Rehabilitation, İstanbul University, Cerrahpaşa Medical Faculty, İstanbul, Turkey.

Objectives: We aimed to evaluate balance using the Tetrax Interactive Balance System (TIBS) in patients with Chiari type I malformation (CM-I) and to assess their fall risk with other clinical parameters.

Patients And Methods: This cross-sectional, prospective study was conducted at physical medicine and rehabilitation outpatient clinics and neurosurgery department of a university hospital between December 2013 and December 2014. The study included a total of 36 patients (31 females, 5 males; mean age 40.6±10.0 years; range, 18 to 60 years) with CM-I. Dynamic balance was assessed using the Berg Balance Scale (BBS), and posturographic examinations were performed using the TIBS.

Results: The mean Fall Risk Index (FI) value was 42.4±29.8 and the mean BBS score was 55.5±1.5. The most common complaints were neck pain (94.4%), headache (88.9%), paresthesia (86.1%), fatigue (83.3%), and vertigo (80.6%). The mean tonsillar herniation below the foramen magnum was 8.7±3.8 (mm). Of the patients, 15 (42.85%) had syringomyelia. The degree of tonsillar ectopia was statistically significantly lower in patients with syringomyelia (p<0.05). The BBS scores were near identical among the patients with or without syringomyelia, although the FI values were lower in the patients with syringomyelia. Comparing cerebellar ectopia ≤9 mm versus >10 mm, the FI values were slightly higher in the patients with ectopia >10 mm, although there was no statistically significant difference in the FI or BBS values.

Conclusion: Our study results suggest that CM-I can decrease the body balance stability and, thus, increase the fall risk. Evaluation of balance in patients with CM using TIBS static posturography is a simple and effective technique.
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http://dx.doi.org/10.5606/tftrd.2019.2003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6648176PMC
March 2019

Acute tetraplegia following laryngotracheal reconstruction surgery.

Surg Neurol Int 2018 16;9:11. Epub 2018 Jan 16.

Department of Neurosurgery, Subdivision of Neuroradiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey.

Background: Paraplegia following thoracic spinal surgery or abdominal operations is usually attributed to spinal cord ischemia due to interruption of the segmental spinal vascular supply. Alternatively, the etiology of spinal cord ischemia following cervical surgery is less clear.

Case Description: A 14-year-old male became acutely tetraplegic with a C4 sensory level and sphincteric dysfunction 12 h following surgery for tracheal stenosis due to prior intubation. Signs included loss of pain and temperature below the level of C4 with preservation of deep sensations (position and vibration) and mute plantar responses. The cervical magnetic resonance imaging revealed diffuse intramedullary cord swelling between C2-C7 and hyperintense signal changes in the anterior and posterior columns of the cord on T2-weighted images. Various etiologies for this finding included a cervical hyperextension or hyperflexion injury vs. anterior spinal artery syndrome.

Conclusions: Postoperative treatment of spinal cord ischemia attributed to cervical and thoracoabdominal surgery is largely ineffective in reversing major neurological deficits. Therefore, it is critical to prevent ischemia during these procedures by the avoidance of coagulopathies, anemia, hypotension, and hyperflexion/hyperextension maneuvers.
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http://dx.doi.org/10.4103/sni.sni_405_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5791509PMC
January 2018

TH1 and TH2 Cytokines Production and NK Cell Level Assessment in Peripheral Blood of Patients with DDH.

Indian J Surg 2013 Aug 1;75(4):294-7. Epub 2012 May 1.

Neurosurgery, Cerrahpasa Medical Faculty,Istanbul University, Istanbul, Turkey.

In this study, our aim is; if the studies will quide us in peripheral blood, for the changes in inflammatory cytokine levels we defined before DDH tissue. Twenty-six patients were suggestive of lumbar DDH were included in this study. Control subjects included 14 autopsy cases. From each patient, disc tissues and peripheral blood samples for plasma were collected during the surgery. For the controls, disc samples and blood for plasma by intracardiac puncture were obtained during autopsy. The Flow Cytometry was used to obtain the lymphocyte CD56 (NK). The Luminex was used to obtain IL-2, IL-4, IL-10, IL-12, IFN-gamma, in both plasma and disc tissues. The results were compared between the two groups. Comparing the two groups regarding plasma demonstrated that IL-2, IL-4, IL-12, IFN-gamma were significantly higher than in patients than those of the controls. Likewise, tissue levels of IL-2, IL-4, IL-10, IL-12, TNF-alpha, CD56 were found to be significantly higher in the patients. With respect to the comparison between the plasma disc samples in the patients, plasma showed significant higher levels of IL-2, IL-12 on the other hand IL-4 was found to be significantly higher in the disc samples. Findings suggest that only tissue samples responses in occurring but not blood samples. We don't think our results in peripheral blood will guide us specifically in DDH.
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http://dx.doi.org/10.1007/s12262-012-0488-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3726805PMC
August 2013

How analgesia-sedation alters monocyte mCD14 and HLA-DR levels in patients undergoing cerebral angiography?

Turk Neurosurg 2013 ;23(6):791-5

Istanbul University, Cerrahpasa Medical Faculty, Department of Physiology, Istanbul, Turkey.

Aim: This study aims to evaluate how analgesia-sedation causes alterations of HLA-DR and cytokines (IL-10 and IL-6) in patients undergoing cerebral angiography for several cerebral vascular diseases.

Material And Methods: This study includes 41 males who underwent cerebral angiography. The study sample was divided into two: Group I had 7 patients who did not receive and group II had 34 patients who received analgesia-sedation before cerebral angiography. A venous blood sample was collected before and after cerebral angiography.

Results: Analgesia-sedation caused significant increase CD4+ and CD19 T lymphocytes (p < 0.001) but group I showed significant increase in CD40, CD154, and MHC-II levels (p < 0.001) after cerebral angiography.

Conclusion: We suggest that the effects of fentanyl and midazolam on the immune response are the reflection of the effects by the monocyte, mHLA-DR expression. In the future, depending on the immunological status of the patients, different anesthetic applications including the new anesthetic agents that will be able to decrease immune system suppression will be required.
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http://dx.doi.org/10.5137/1019-5149.JTN.8218-13.0DOI Listing
July 2014

Pallidal deep brain stimulation in a 5-year-old child with dystonic storm: case report.

Turk Neurosurg 2013 ;23(1):125-8

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

A 5-year-old child had a medical history of epilepsy and a newly presented mental retardation with a life-threatening dystonic storm. Neuroimagings showed bilateral calcification of the pallidum. Several treatment modalities were performed, but the symptoms showed no significant improvement. The patient was operated on in order to place a deep brain stimulation (DBS) targeting bilateral globus pallidum internus (GPi). The dystonia showed a remarkable improvement after surgery, with 81% reduction of dystonia severity after 15 months. To our best knowledge, this is the youngest patient mentioned in the literature to be treated with DBS, which was also life-saving in this case.
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http://dx.doi.org/10.5137/1019-5149.JTN.4579-11.0DOI Listing
July 2013

Unilateral thalamic Vim and GPi stimulation for the treatment of Holmes' tremor caused by midbrain cavernoma: case report and review of the literature.

J Neurol Surg A Cent Eur Neurosurg 2013 Jul 14;74(4):271-6. Epub 2013 Jan 14.

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

A 30-year-old man with brainstem cavernoma experienced hemorrhage and was operated in 2008. Six months after the operation, the patient presented with new complaints of left arm tremor namely Holmes' tremor. Neurological examination also revealed left-sided internuclear ophthalmoplegia, left-sided mild paresis, and increased deep tendon reflexes of the left upper extremity, truncal ataxia, and dysarthria. Brain magnetic resonance imaging showed a postoperative cavity and gliosis at the level of the superior and inferior colliculus in the right tegmentum and right red nucleus with extension to the substantia nigra. Fahn-Tolosa-Marin tremor rating scale (TRS) for his left upper extremity (Part A, score 6) was 11 for the proximal and the distal arm. After the failure of medical treatment, the patient underwent right globus pallidum internus and ventral intermediate thalamic nucleus deep brain stimulation. There were no side effects related to the stimulation. Final TRS months after operation was 3 for the proximal and 4 for the distal arm.
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http://dx.doi.org/10.1055/s-0032-1322549DOI Listing
July 2013

The effects of analgesia-sedation on the immune system before and after cerebral digital subtraction angiography.

Turk Neurosurg 2011 ;21(3):340-6

Istanbul University, Cerrahpasa Faculty of Medicine, Department of Anesthesiology and Reanimation, Istanbul, Turkey.

Aim: Cerebral digital subtraction angiography (DSA) is an invasive procedure and may cause inflammatory responses in the body. This study aims to provide cytokine and lymphocyte profile in a population of patients underwent cerebral DSA.

Material And Methods: Forty-one male patients who admitted for cerebral DSA were included in this study. Patients were divided into two groups: Group I (n = 7) included patients who did not receive analgesia-sedation and group II (n = 34) received analgesia-sedation before procedure. For the molecules, a venous blood samples from every patient was collected before and after cerebral DSA.

Results: Cytokine levels in group I showed a trend to increase in the majority of the molecules after the procedure except IL-1β. In group II, cytokines showed variable trend. When comparing the two groups regarding cytokine levels after cerebral DSA, IL-1β, IL-10, IL-12, and IFN-γ levels increased significantly in group II. Comparing the two groups with respect to lymphocytes after cerebral DSA showed that CD56 levels were significantly higher in group II and other parameters did not show significant differences.

Conclusion: It can be possible that delimitation of the action(s) of the cytokines affecting the secretion or activation of CD56 (natural killer) may avoid complications of inflammation after invasive procedures.
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http://dx.doi.org/10.5137/1019-5149.JTN.4296-11.1DOI Listing
December 2011

Treatment of homocystinuria-related dystonia with deep brain stimulation: a case report.

Stereotact Funct Neurosurg 2011 20;89(4):210-3. Epub 2011 May 20.

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

A 23-year-old woman with the medical history of homocystinuria that had been diagnosed at the age of 14 has been non-responsive to treatment. The patient presented with the symptoms of dysphonia, dysarthria and severe dystonia of the neck and left extremities. Blood and urine biochemistry revealed high levels of homocystine. Brain magnetic resonance imaging was normal with no detectable pathologies. Medical treatment strategies were used and repeated injections of botulinum toxin A were administered, but the symptoms showed no significant improvement. The patient was then operated, and deep brain stimulators targeting the bilateral globus pallidus internus were implanted. After the activation of the electrodes, dystonia symptoms showed a remarkable improvement. Good outcome was documented during the follow-up period of 7 months. To our best knowledge, this is the first reported case of homocystinuria-related dystonia symptoms that were successfully treated with deep brain stimulation.
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http://dx.doi.org/10.1159/000325703DOI Listing
January 2012

Catabolic cytokine expressions in patients with degenerative disc disease.

Turk Neurosurg 2010 Oct;20(4):492-9

Cerrahpasa Medical Faculty Department of Physiology Istanbul, Turkey.

Aim: Lumbar degenerative disc disease (DDD) is a common disease of advanced age characterized by progressive changes in the intervertebral disc and associated structures. There have been great efforts for years to explain its pathophysiological mechanism(s). This study aims to provide cytokine profile and in addition to the lymphocytes in a population of patients with lumbar DDD.

Material And Methods: Twenty-six patients whose clinical and radiological features were suggestive of lumbar DDD that underwent surgery and 14 autopsy cases as control were included. Patient disc samples were obtained during surgery whilst disc materials were collected during autopsy procedures from the controls. Major cytokines and lymphocytes were studied by using the flow cytometry method.

Results: Significantly higher levels in disc samples in relation to IL-1β, IL-2, IL-4, IL-10, IL-12, TNF-α, CD8, CD56, CD19, and CD40 were found in the patients compared to the controls. Positive correlations were shown between CD3/CD4, CD25/CD3, CD25/CD4, CD19/CD4 but negative correlations were shown between CD19/CD3 and CD25/CD19 in both groups.

Conclusion: The findings suggest that both local inflammatory responses occur in lumbar DDD. Using specific cytokines either by local or systemic application may reverse the degenerative process.
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http://dx.doi.org/10.5137/1019-5149.JTN.3394-10.1DOI Listing
October 2010

Bilateral C1-C2 claw for atlantoaxial instability.

Turk Neurosurg 2009 Oct;19(4):345-8

I.U. Cerrahpaşa Medical Faculty, Neurosurgery Department, Istanbul, Turkey.

Objective: Atlantoaxial stability can be achieved by laminar hook systems via posterior approach. This technique is much more safer than using screws. We presented our experience with the C1-C2 claw procedure.

Methods And Material: Seven patients with atlantoaxial instability were operated by using C1 and C2 hooks, rods and transverse connector at Neurosurgery Clinic of Istanbul University Cerrahpasa Medical Faculty between the years 2005 and 2008.

Results: Satisfactory stabilization was achieved in all patients. Operative complication or instrumentation failure was not observed.

Conclusions: C1-C2 claw is a safe technique and adequate stabilization is achieved with the use of a transverse connector.
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October 2009

Intracranial hypotension following scoliosis surgery: dural penetration of a thoracic pedicle screw.

Eur Spine J 2008 Sep 25;17 Suppl 2:S347-50. Epub 2008 Apr 25.

Department of Radiology, Division of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

The authors report on a 14 years old female with intracranial hypotension who had a history of spinal instrumentation surgery for scoliosis 3 months prior to her admission. She had been diagnosed with migraine in a neurology clinic and was under medical therapy when presented. During the investigation process, a right thoracic pedicle screw, which was penetrating and transversing the dura mater at the T3-T4 level was identified. The diagnosis and management of such a case is discussed. Knowledge of this entity is of extreme importance to spine surgeons, in order to prevent delayed diagnosis and possible complications.
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http://dx.doi.org/10.1007/s00586-008-0681-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2525906PMC
September 2008

Concomitant fracture of bilateral occipital condyle and inferior clivus: what is the mechanism of injury?

Eur Spine J 2007 Dec 19;16 Suppl 3:261-4. Epub 2006 Dec 19.

Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, P.O. Box: 9, Cerrahpasa, Aksaray, 34303, Istanbul, Turkey.

With the routine use of multi-slice high resolution computed tomography, increasing number of occipital condyle fractures have been reported in the last decade. The authors report a very rare case of bilateral occipital condyle fracture complicated by the fracture of the inferior clivus and discuss the possible mechanisms of injury.
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http://dx.doi.org/10.1007/s00586-006-0270-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2148078PMC
December 2007

Intrathecal baclofen toxicity and deep coma in minutes.

J Spinal Cord Med 2006 ;29(3):237-9

Istanbul University, Cerrahpasa Medical Faculty, Department of Anesthesiology, Istanbul, Turkey.

Background/objective: In recent years, intrathecal baclofen (ITB) treatment in patients with refractory spasticity has been accepted as an effective therapy. However, this treatment modality may cause life-threatening complications. This report describes the clinical presentation, unfamiliar dilemmas, and treatment of a patient with ITB toxicity and raises awareness of problems that may arise.

Methods: A 33-year-old man with refractory spasticity due to diffuse white matter injury was admitted for ITB treatment. The patient had respiratory difficulty followed by a generalized seizure and developed coma minutes after the drug administration. The patient was transferred into an intensive care unit immediately and managed accordingly.

Results: After proper management, the patient was followed and continued to receive ITB treatment.

Conclusions: ITB therapy is a very effective method of rehabilitation and medication in patients with refractory spasticity, but physicians must be aware of the serious complications that may develop just minutes after the drug is administered. Although safe, baclofen pumps are nevertheless mechanical devices that may malfunction. Therefore, physicians should be mindful of the possibility of life-threatening complications that may develop and lead to a patient's death if proper treatment is not performed.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1864812PMC
http://dx.doi.org/10.1080/10790268.2006.11753880DOI Listing
August 2006

Traumatic peripheral nerve injuries: demographic and electrophysiologic findings of 802 patients from a developing country.

J Clin Neuromuscul Dis 2006 Mar;7(3):97-103

Departments of *Neurology daggerNeurosurgery, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey.

Objective: To study a series of patients with traumatic peripheral nerve injury during the past 10 years in Cerrahpasa Medical Faculty/Istanbul/Turkey.

Methods: The chart review of 802 patients was evaluated and we explored the type(s) and cause(s) of injury, and electromyographic findings. The study included 171 children and 631 adults and we excluded the patients who suffered from injuries due to the Marmara earthquakes that occurred in 1999.

Results: Injury was most common in the upper extremities in both children (78.36%) and adults (63.54%). The common causes of nerve injury in children were as follows: obstetric lesions (46.78%), iatrogenic lesions (16.95%), traffic accidents (15.7%), and sharp lacerations (12.8%), whereas the commonest cause of nerve injury in adults was due to sharp lacerations (27.57%), followed by iatrogenic lesions (25.67%), and traffic accidents (23.77%). The most commonly injured nerves were the brachial plexus and ulnar nerve in children and adults, respectively. Electromyography demonstrated that complete nerve injury predominated in both groups.

Conclusions: If preventive measures are taken into consideration satisfactorily, the incidence of disabling peripheral nerve injury may decrease, as such injuries are often treatable.
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http://dx.doi.org/10.1097/01.cnd.0000203641.38887.63DOI Listing
March 2006

Finite element method based stress analysis of zone I and zone II sacral fractures.

Ulus Travma Acil Cerrahi Derg 2005 Jul;11(3):189-94

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

Background: Sacral bone fractures after direct traumas such as gunshot wounds and blunt sacral traumas are rarely, whereas those occurring after indirect traumas with vertical shear mechanisms ( car accidents or falls) are more frequently seen.

Methods: A cadaver sacrum was modelled 3-dimensionally using finite element software. Left sacroiliac joint was modeled to simulate a 75- kg man falling on one leg from a height of 5 meters. An impact load of 10 kN was transferred to the sacrum via intervertebral disc surface and two facets. Von Mises equivalent stress distribution was estimated.

Results: Von Mises stress distribution was calculated for sacral ala (430 MPa), S1 pedicle (225 MPa), and S1 lamina (35 MPa). Stress values were 200 Mpa, 130 Mpa, 105 Mpa, and 55 MPa on ventrolateral, dorsomedial, ventromedial and dorsolateral sides of S1 foramen respectively. Vertical shear injury caused stress distribution to concentrate at sacral ala and S1 pedicle (zone I). Local stress distribution around S1 foramen is concentrated ventrolaterally

Conclusion: High incidence of zone I sacral fractures and low incidence of neurological deficits could be explained by concentration of stress at sacral ala. Zone II fractures might be due to by transfer of triggered stresses from sacral ala and S1 pedicle to ventrolateral side of S1 foramen.
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July 2005

In vitro investigation of heat transfer in calf spinal cord during polymethylmethacrylate application for vertebral body reconstruction.

Eur Spine J 2006 Mar 24;15(3):341-6. Epub 2005 May 24.

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

The objective of this experimental study was to investigate the temperature variations within the spinal cord of calf cadavers during polymethlymethacrylate (PMMA) application for vertebral body reconstruction. Cervical spines including the cervical spinal cord of ten fresh cadavers were used. Corpectomy and laminectomy were performed and dura was exposed at the same level for proper placement of thermal sensors. Sensors were placed in multiple holes in the spinal cord at depths of 3, 6, 9 and 12 mm, respectively. Whether the thermal sensors were placed in the gray or white matter was determined by computerized tomography. The white and gray matters of the spinal cord exhibited different thermal properties. The white matter was more conductive and absorbed less heat than the gray matter. The heat sensor nearest to PMMA exhibited temperatures of 42-44 degrees C. The second heat sensor placed at 9 mm depth within the gray matter showed 44 degrees C. The third sensor, which was placed at 6 mm depth within the spinal cord recorded the same temperature as the first, i.e., nearest to PMMA sensor. The fourth heat sensor, which was at the farthest location from PMMA demonstrated 37-39 degrees C. The temperature distribution within the gray matter was inversely proportional to the distance from the heat source. The temperature at the dorsal white matter, which was distant from the heating source, remained nearly constant and was not elevated. Our data suggest that thermal injury to the spinal cord during PMMA application may be expected to be more significant in the gray matter when compared with other neural tissues.
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http://dx.doi.org/10.1007/s00586-004-0869-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3489292PMC
March 2006
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