Publications by authors named "Sait Naderi"

90 Publications

Pediatric age, posterior fossa meningioma.

Neurosciences (Riyadh) 2021 Apr;26(2):212-215

From the Department of Neurosurgery (Onen, Yüvrük), VM Maltepe Medicalpark Hospital, Department of Neurosurgery (Sarikaya, Naderi), Umraniye Teaching and Research Hospital, Istanbul, Turkey.

Meningiomas are benign, slow-growing tumors originating from arachnoid gap cells. They constitute 15%-20% of all intracranial tumors in adults and 04%-4% in the pediatric age group. Meningiomas in the posterior fossa in the pediatric period do not initially come to mind. In the case presented here, there was a cystic meningioma showing heterogenous contrast and obstructive hydrocephaly was observed associated with 4th ventricle pressure. the tumor was totally removed, then the ventriculo peritoneal shunt was applied.
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http://dx.doi.org/10.17712/nsj.2021.2.20200151DOI Listing
April 2021

LAMINA MEASUREMENTS WITH COMPUTED TOMOGRAPHY FOR C2 TRANSLAMINAR SCREW FIXATION IN PEDIATRIC AND ADULT CASES.

Turk Neurosurg 2020 Dec 10. Epub 2020 Dec 10.

Umraniye Teaching and Research Hospital.

Aim: C2 translaminar fixation has been introduced to decrease the risks associated with C2 pedicle fixation. The aim of this study was to measure C2-related morphometric parameters in a Turkish population.

Material And Methods: The computed tomography (CT) images of three groups (Group 1: paediatric cases aged 1-6 years, Group 2: age7-16 years, and Group 3: adult cases), who had cervical spine CT were used to measure some morphometric parameters for safe C2 translaminar screw fixation. The measured parameters included thickness, height and length of the C2 lamina on both sides and the C2 lamina-midline angle.

Results: C2 lamina thickness at the thinnest point on the right and left sides was found to be 4.4±0.5mm and 4.6±0.5mm in Group 1, 5.3±0.8mm and 5.6±0.8 mm in Group 2, and 6.8±1.4mm and 7.0±1.5mm in Group 3, respectively(p 0.05). The height of the C2 lamina at the thinnest point on the right and left sides was found to be 5.8±0.8mm, and 5.8±0.7 mm in Group 1, 10.4±1.4 mm and 10.6±1.4 mm in Group 2, and 10.6±1.8mm, and 10.7±1.5mm in Group 3, respectively(p 0.05). The mean length of the C2 lamina was found to be 20.6±2.4mm in Group 1, 31.4±4.1 mm in Group 2, and 36.7±3.3mm in Group 3 (p 0.05). There was no significant difference between Group 2 and Group 3 in respect of mean lamina angle (44 o vs 45o) but it was lower in Group 1 (35o).

Conclusion: This study revealed the appropriateness of C2 anatomy for safe C2 translaminar screw fixation.
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http://dx.doi.org/10.5137/1019-5149.JTN.32230-20.2DOI Listing
December 2020

Illumination of The Relationship between Ureter and Intervertebral Disc by Computed Tomography.

Turk Neurosurg 2021 Feb 3. Epub 2021 Feb 3.

Health Sciences University, Istanbul Umraniye Training and Research Hospital, Department of Radiology, Istanbul, Turkey.

Aim: to show the relationship of lumbar intervertebral disc with the ureters with computerized tomography.

Material And Methods: A total of 80 patients (M/F:42/38) with a mean age of 45 were included in our retrospective study.The patients were divided into two groups ( male as group 1, and female as group2). Later, these two groups were divided into two groups as under 55 year-old (Group 1A and, group 2A) and over 55 year-old (Group 1B and, Group 2B). An imaginary line passing through the tangential to posterior cortex of the body at the intervertebral disc level (line a) was drawn. Two lines were drawn from the ureters perpendicular to this line (line b). The lines of the cortex where the a-line was cut ( c point ) were also drawn from the contralateral ureter (d line). Line b and d distances were measured. Another line was drawn from both c points to the ipsilateral ureters ( line x). The angle between line a and line x was measured ( x angle).

Results: The right kidney hilus was more inferior than the left kidney hilus. There was a significant negative correlation between the b line and the lumbar level (r:-0,95). The average length of the b line was 2,1 cm at lower lomber levels. There was a positive correlation between X angle and lumbar level ( p 0.05). The X angle was increased from 38° to 80° as descend to the lower lumbar levels. X angle was significantly higher in male patients (p 0,05). No significant correlation was found between the d line and the lumbar level.

Conclusion: Computed tomography is an illuminating modality in order to elucidate the relationship between intervertebral disc and ureter preoperatively and to visualize retroperitoneum.
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http://dx.doi.org/10.5137/1019-5149.JTN.32650-20.4DOI Listing
February 2021

Spinal Hemangioblastomas and Neuropathic Pain.

World Neurosurg 2021 Feb 1. Epub 2021 Feb 1.

Department of Neurosurgery, Health Sciences University, Ümraniye Training and Research Hospital, Istanbul, Turkey.

Background: Spinal hemangioblastomas (SHs) are rare and benign tumors. Primary symptoms include pain, hypoesthesia, and neuropathic pain (NP). Clinical symptoms may be as a result of tumor mass effect, peritumoral effect, syrinx, or venous congestion. No studies have focused on NP in SHs. The objective of this study was to review the rate and causes of NP in patients with SHs.

Methods: The present study comprises a retrospective analysis of 13 patients with spinal hemangioblastomas. For the retrospective analysis of the patients, we analyzed the absence or presence of NP in the pre- and postoperative periods and its relationship with the level, location, and size of the tumor, as well as the size and location of the syrinx.

Results: Postoperative NP was detected in 6 out of 13 patients. All 6 patients' tumors were located at the dorsal aspect of the spinal cord. There was a predominance of rostral syrinx location in patients with NP. Tumor size and level and syrinx size and level were not found to affect the occurrence of NP.

Conclusions: The present study shows that NP is observable in both pre- and postoperative periods. Proximity of the tumor to the dorsal root entry zone, and especially the presence of rostral syrinx, are the main factors affecting postoperative NP symptomatology. It is concluded that the combination of these factors and iatrogenic injury of anatomic pathways of NP within the spinal cord are responsible for postoperative NP.
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http://dx.doi.org/10.1016/j.wneu.2021.01.100DOI Listing
February 2021

A Novel Perspective for Analyzing Craniocervical Sagittal Balance and Horizontal Gaze.

World Neurosurg 2021 Jan 28. Epub 2021 Jan 28.

University of Health Sciences, Umraniye Training and Research Hospital, Department of Neurosurgery, Istanbul, Turkey.

Background: This study aimed to analyze craniocervical sagittal balance parameters in an asymptomatic population revealing the interaction of craniocervical compensation with the horizontal gaze and to identify a new parameter that can be evaluated more easily with the horizontal gaze.

Methods: Lateral radiographs were taken of the 75 asymptomatic volunteers. Two independent observers measured the pelvic, spinal, and cranial parameters, spinocranial angle, and C2-7 sagittal vertical axis (C2-7SVA) distances. The correlations between these parameters and the differences in the created subgroups were analyzed.

Results: Correlations were found between the sacral slope and L1-L5 lordosis (r = 0.700), between L1-L5 lordosis and thoracic kyphosis (r = 0.363), between thoracic kyphosis and C2-7 lordosis (r = 0.425), and between C2-7 lordosis and C2 slope (C2S) (r = -0.735). In addition, this chain was extended to include the cranium, showing a strong correlation between the C2S and the cranial slope (CS) (r = -0.827). Strong correlations were observed between the CS and C2S (r = -0.827), C2-C7 lordosis (r = 0.583), C2-7 SVA (r = -0.437). The importance of O-C2 lordosis was significantly increased in the patient cohort with a prominent C2S (≥13) and became the main determinant of the CS (r = 0.667) together with the C2S (r = -0.800).

Conclusions: The factors affecting horizontal gaze are C2S, C2-7 lordosis, O-C2 lordosis, and C2-7 SVA. C2S can be used as an indicator of the horizontal gaze in preoperative surgical planning and postoperative evaluation.
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http://dx.doi.org/10.1016/j.wneu.2021.01.077DOI Listing
January 2021

Acute Neurologic Deterioration in Mobile Spinal Schwannoma.

World Neurosurg 2021 Feb 16;146:270-273. Epub 2020 Nov 16.

Department of Neurosurgery, University of Health Sciences, Umraniye Teaching and Research Hospital, Istanbul, Turkey.

Background: Spinal schwannomas are commonly presented with minor symptoms, including radicular pain, sensory deficits, and minor neurologic deficit. Acute neurologic deterioration is uncommon.

Case Description: In this study, a case of cauda equina schwannoma presented with acute neurologic deficit after movement of spinal schwannoma is presented.

Conclusions: It is noted that movement of spinal schwannoma and resultant acute neurologic deterioration should be considered during the follow-up.
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http://dx.doi.org/10.1016/j.wneu.2020.10.142DOI Listing
February 2021

The Application of an Enhanced Recovery After Surgery to Spine Instrumentation.

Turk Neurosurg 2020 ;30(5):707-713

Umraniye Training and Research Hospital, Department of Anesthesiology, Istanbul, Turkey.

Aim: To evaluate the clinical and economic outcomes of the adoption of the enhanced recovery after spine surgery (ERSS) program in patients undergoing spine instrumentation.

Material And Methods: This study described the introduction of the ERSS program, and we compared 86 consecutive patients who participated in ERSS with a retrospective cohort of 88 patients who underwent the same surgery before the implementation of this program. Groups were compared in terms of age, sex, body mass index (BMI), American Society of Anesthesiologist (ASA) physical scores, operative time, comorbidities, intraoperative blood loss, blood transfusion rate, first oral intake, time of first mobilization, length of hospital stay, preoperative and postoperative pain scores using a numeric pain rating scale, 30-day readmission and complication rates, and total cost.

Results: Groups were similar in terms of age, sex, BMI, ASA scores, and comorbidities. Intraoperative blood loss, blood transfusion rate, and length of hospital stay were lower in the ERSS group. First oral intake and first mobilization occurred earlier in the ERSS group. Postoperative pain scores were significantly lower in the ERSS group. Operative time, readmissions, or complications at 30 days did not statistically differ between the two groups. The ERSS group was found to be significantly cost effective.

Conclusion: ERSS is feasible, comprehensive, and cost effective for spine instrumentation with better perioperative outcomes.
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http://dx.doi.org/10.5137/1019-5149.JTN.28828-19.1DOI Listing
December 2020

The Application of an Enhanced Recovery After Spine Surgery to Lumbar Instrumentation.

Turk Neurosurg 2020 Mar 16. Epub 2020 Mar 16.

Umraniye Training and Research Hospital, Department of Anesthesiology, Istanbul, Turkey.

Aim: Enhanced recovery after surgery(ERAS) is a set of multidisciplinary evidence-based strategies to prepare patients for surgery and to accelerate the recovery process postoperatively while improving surgical outcomes. Despite success in several subspecialties, enhanced recovery after spine surgery(ERSS) has yet to be established. We hypothesized that such a program would have a significant influence on clinical and economic outcomes in spine instrumentation.

Material And Methods: This study describedthe introduction of the ERSSprogram, and we compared 86 consecutive patients who participated in ERSS with a retrospective cohort of 88 patients who underwent the same surgery before the implementation of thisprogram. Groups were compared in terms of age, sex, body mass index (BMI), American Society of Anesthesiologist (ASA) physical scores, operative time, comorbidities, intraoperative blood loss, blood transfusion rate, first oral intake, time of first mobilization, length of hospital stay, preoperative and postoperative pain scores using anumeric pain rating scale,30-day readmission andcomplication rates, and total cost.

Results: Groups were similar in terms of age, sex, BMI, ASA scores, and comorbidities. Intraoperative blood loss, blood transfusion rate, and length of hospital stay were lower in the ERSS group. First oral intake and first mobilization occurred earlier in the ERSS group. Postoperative pain scores were significantly lower in the ERSS group. Operative time, readmissions, or complications at 30 days did not statistically differ between the two groups. The ERSS group was foundto besignificantly cost effective.

Conclusion: ERSS is feasible, comprehensive, and cost effective for spine instrumentation with better perioperative outcomes.
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http://dx.doi.org/10.5137/1019-5149.JTN.28828-19.1DOI Listing
March 2020

Prognostic Value of Craniovertebral Junction Diffusion Tensor Imaging in Patients with Chiari Type 1 Malformation.

Turk Neurosurg 2020 ;30(3):400-406

University of Health Sciences, Okmeydani Teaching and Research Hospital, Department of Neurosurgery, Istanbul, Turkey.

Aim: To examine the spinal cord status by using diffusion tensor imagıng (DTI) and tractography preoperatively and postoperatively in patients with Chiari malformation type 1 (CM1) and compare the results with the data obtained from healthy people.

Material And Methods: Overall, 48 patients (33 patients with CM1, and 15 in the control group for DTI and tractography measurements) were included in the study. Mean age was 37.7 ± 11.8 years (minimum and maximum: 12 and 57 years). The DTI and tractography data were obtained from the craniocervical region in patients with CM1 and control group. Patients with CM1 were operated using the suboccipital decompression technique without opening the dura. Surgical results were evaluated using Chicago Chiari Outcome Scale (CCOS) and Asgari scale.

Results: Based on the CCOS and Asgari scale results, the surgical technique was determined to be clinically beneficial. The DTI and tractography values from the pontobulbar, cervicomedullary, and spinal cord C3â€"4 levels in patients with CM1 were compared to those of the control group. These values were observed to be near normal after surgery in patients with CM1.

Conclusion: Based on the improvement in DTI-tractography data observed in our study, DTI and tractography can serve as a guiding measurement method for assessing the prognosis of patients with CM1.
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http://dx.doi.org/10.5137/1019-5149.JTN.27144-19.2DOI Listing
October 2020

Measurement of spinal root angle at spinal canal and foraminal levels in cases of facet arthropathy: T2-weighted turbo spin echo magnetic resonance myelography with SPACE technique.

Acta Radiol 2020 Jun 25;61(6):821-829. Epub 2019 Oct 25.

Department of Neurosurgery, Health Sciences University, Istanbul Umraniye Training and Research Hospital, Istanbul, Turkey.

Background: Magnetic resonance myelography (MRM) with three-dimensional (3D) T2-weighted (T2W) turbo spin echo (TSE) sampling perfection with application-optimized contrasts using different flip angle evolution (SPACE) may be a guide to the etiology of low back pain.

Purpose: To research the efficiency of a 3D T2W TSE SPACE MRM sequence for visualization of anatomic details of spinal nerve root at the spinal canal and lateral recess levels in the patients with low back pain.

Material And Methods: Lumbar spinal MRM 3D T2W TSE SPACE was performed in a total of 70 patients (median age 46 years). Patients were imaged while lying in a supine position with straightened legs. According to the degree of facet arthropathy findings, patients were divided into four separate subgroups in our retrospective cross-sectional study. Spinal nerve root angle was measured within the spinal canal and at lateral recess level, and facet joint angle and lumbar lordosis measurements were measured by two radiologists, independently.

Results: Lumbar level was strongly negatively correlated with facet joint angle (r = -0.95) as well as nerve root angle within the spinal canal (NRA) (r = -0.857) and at the lateral recess level (NRA) (r = -0.947). Intracanal decline of the spinal root angle caused by spinal stenosis findings was also observed ( < 0.05). For the measurements of NRA and NRA, inter-observer correlation was 0.85 and 0.82 for the spinal canal and at lateral recess level, respectively.

Conclusion: 3D T2W SPACE in NRA and NRA provided high resolution images for evaluation. Therefore, this method may be a qualitative guide for the clinician and the surgeon in terms of root anatomy before any intervention.
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http://dx.doi.org/10.1177/0284185119881744DOI Listing
June 2020

Management and prognosis of acute traumatic cervical central cord syndrome: systematic review and Spinal Cord Society-Spine Trauma Study Group position statement.

Eur Spine J 2019 Oct 31;28(10):2390-2407. Epub 2019 Jul 31.

Department of Orthopedics, University of Pretoria, Pretoria, South Africa.

Purpose: Spinal Cord Society (SCS) and Spine Trauma Study Group (STSG) established a panel tasked with reviewing management and prognosis of acute traumatic cervical central cord syndrome (ATCCS) and recommend a consensus statement for its management.

Methods: A systematic review was performed according to the PRISMA 2009 guidelines. Delphi method was used to identify key research questions and achieve consensus. PubMed, Scopus and Google Scholar were searched for corresponding keywords. The initial search retrieved 770 articles of which 37 articles dealing with management, timing of surgery, complications or prognosis of ATCCS were identified. The literature review and draft position statements were compiled and circulated to panel members. The draft was modified incorporating relevant suggestions to reach consensus.

Results: Out of 37 studies, 15 were regarding management strategy, ten regarding timing of surgery and 12 regarding prognosis of ATCCS.

Conclusion: There is reasonable evidence that patients with ATCCS secondary to vertebral fracture, dislocation, traumatic disc herniation or instability have better outcomes with early surgery (< 24 h). In patients of ATCCS secondary to extension injury in stenotic cervical canal without fracture/fracture dislocation/traumatic disc herniation/instability, there is requirement of high-quality prospective randomized controlled trials to resolve controversy regarding early surgery versus conservative management and delayed surgery if recovery plateaus or if there is a neurological deterioration. Until such time decision on surgery and its timing should be left to the judgment of physician, deliberating on pros and cons relevant to the particular patient and involving the well-informed patient and relatives in decision making. These slides can be retrieved under Electronic Supplementary Material.
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http://dx.doi.org/10.1007/s00586-019-06085-zDOI Listing
October 2019

A Simple Cost-Effectiveness Analysis of Bilateral Decompression via Unilateral Approach versus Instrumented Total Laminectomy and Fusion for Lumbar Spinal Stenosis.

Turk Neurosurg 2019 ;29(5):643-650

University of Health Sciences, Umraniye Training and Research Hospital, Department of Neurosurgery, Istanbul, Turkey.

Aim: To compare the clinical and economic results of two different surgical approaches (bilateral decompression via unilateral approach and instrumented total laminectomy and fusion) in the treatment of lumbar spinal stenosis.

Material And Methods: The clinical, surgical, and economic aspects of 100 surgically treated patients with lumbar spinal stenosis were retrospectively reviewed.

Results: Decompression was performed at 158 levels in 100 patients. The most commonly decompressed levels were L4-5 and L3-4. Significant difference was observed between pre- and postoperative visual analog scale scores in both groups (p < 0.05). In Group 1 (instrumented total laminectomy and fusion), the mean surgery cost was 2539.2 USD (mean procedure cost: 1440.1 USD, mean implant cost: 1099.2 USD). In Group 2 (bilateral decompression via unilateral approach) the mean surgery cost was 998.5 USD. The cost difference was significant (p < 0.05).

Conclusion: Both instrumented total laminectomy and fusion and bilateral decompression via unilateral approach performed with and without stabilization showed similar clinical results in patients with lumbar spinal stenosis. However, the cost of surgery was found to be 2.5-fold higher in the instrumented total laminectomy and fusion group. This study supports the concept that minimally invasive spine surgery is cost-effective.
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http://dx.doi.org/10.5137/1019-5149.JTN.24318-18.1DOI Listing
December 2019

Effects of Anesthesia Protocol on Perioperative Outcomes and Costs of Lumbar Microdiscectomies.

Turk Neurosurg 2019 ;29(6):843-850

Umraniye Training and Research Hospital, Department of Anesthesiology, Istanbul, Turkey.

Aim: To compare the effects of spinal anesthesia (SA) and general anesthesia (GA) in lumbar microdiscectomy in terms of their costeffectiveness, and perioperative outcomes.

Material And Methods: We randomly allocated 100 consecutive patients who were scheduled to undergo elective lumbar microdiscectomy, into either SA or GA groups. We recorded and evaluated various parameters, including demographic aspects, body mass index (BMI), perioperative hemodynamics, time elapsed from operating room (OR) entry until incision, operative time, time elapsed from application of the surgical dressing to exiting OR, blood loss, post anesthetic care unit (PACU) time, preoperative and postoperative pain scores, postoperative analgesic requirements, first mobilization time, first oral intake, the length of hospital stay, time to return to work, and perioperative anesthetic costs. The patients, anesthesiologists, and neurosurgeons were handed a questionnaire before discharge to determine their satisfaction with the procedure.

Results: Several variables were found to be better in the SA group: the mean arterial pressure and heart rate changes were significantly lower, and the time elapsed from OR entry until incision, operative time, time elapsed from application of the surgical dressing to exiting OR, PACU time, the length of hospital stay, and time to return to work were shorter; furthermore, the postoperative pain scores, the analgesic requirements, the intraoperative blood loss, and the cost of anesthesia were all lower. Moreover the first mobilization and oral intake occurred earlier; and most significantly, the satisfaction of the patients and surgeons was higher in the SA group. Furthermore, we encountered no complications.

Conclusion: Based on our results, we conclude that SA is reliable and clinically successful procedure in lumbar microdiscectomy.
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http://dx.doi.org/10.5137/1019-5149.JTN.25737-18.4DOI Listing
February 2020

Does an enhanced recovery after surgery protocol change costs and outcomes of single-level lumbar microdiscectomy?

Neurosurg Focus 2019 04;46(4):E10

2Neurosurgery, Ümraniye Training and Research Hospital, Ümraniye, İstanbul, Turkey.

OBJECTIVEEnhanced recovery after surgery (ERAS) is a multimodal approach that aims to improve perioperative surgical outcomes. The aim of this study was to evaluate the benefits of ERAS in terms of cost-effectiveness and postoperative outcomes in single-level lumbar microdiscectomy.METHODSThis study was a single-center retrospective comparing costs and outcomes before and after implementation of the ERAS pathway. Data were collected from the electronic medical records of patients who had undergone single-level lumbar microdiscectomy during 2 time periods-during the 2 years preceding implementation of the ERAS pathway (pre-ERAS group) and after implementation of the ERAS pathway (ERAS group). Each group consisted of 60 patients with an American Society of Anesthesiologists (ASA) Physical Status Classification of class 1. Patients were excluded if their physical status was classified as ASA class II-V or if they were younger than 18 years or older than 65.Groups were compared in terms of age, sex, body mass index (BMI), perioperative hemodynamics, operation time, intraoperative blood loss, intraoperative fluid administration, intraoperative opioid administration, time to first oral intake, time to first mobilization, postoperative nausea and vomiting (PONV), difference between preoperative and postoperative visual analog scale (VAS) scores, postoperative analgesic requirements, length of hospital stay, and cost of anesthesia.RESULTSThe ERAS and pre-ERAS groups were comparable with respect to age, sex, and BMI. Operation time, intraoperative blood loss, intraoperative opioid administration, and intraoperative fluid administration were all less in the ERAS group. First oral intake and first mobilization were earlier in the ERAS group. The incidence of PONV was less in the ERAS group. Postoperative analgesic requirements and postoperative VAS scores were significantly less in the ERAS group. The length of hospital stay was found to be shorter in the ERAS group. The ERAS approach was found to be cost-effective.CONCLUSIONSERAS had clinical and economic benefits and is associated with improved outcomes in lumbar microdiscectomy.
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http://dx.doi.org/10.3171/2019.1.FOCUS18665DOI Listing
April 2019

The Use of Intraoperative Ultrasonography in Intradural Spinal Tumor Surgery.

Turk Neurosurg 2019 ;29(2):237-241

Heinrich-Braun-Klinikum, Department of Neurosurgery, Zwickau, Germany.

Aim: To review our experience gained from the use of intraoperative ultrasonography (IOUSG) in intradural spinal tumor surgery.

Material And Methods: IOUSG was used during surgery of 69 intradural spinal tumors, operated on between 2012 and 2016. A 5-8 MHz probe of IOUSG was used, before and after durotomy to perform the exact durotomy and myelotomy, and after tumor resection, to detect a residual tumor. A retrospective review of parameters including demographic data, localization and histopathology of the tumour, IOUSG findings, and the amount of tumor resection was made.

Results: In a total of 69 intradural spinal tumors (42 extramedullary, and 27 intramedullary tumors) IOUSG was used during surgery. Total excision was performed in 68 cases, and subtotal excision in one case. Pre-durotomy IOUSG showed sufficient laminectomy in 62 cases. In 7 cases, as the IOUSG failed to show all borders of the tumor, laminectomy was extended.

Conclusion: IOUSG is an important tool, which contributes to intradural spine surgery. This modality shows the tumor appearance before durotomy, and is therefore helpful in deciding the amount of laminectomy and duratomy in addition to the exact location of myelotomy. It also provides the surgeon with information about residual tumor after excision, thereby increasing the safety and success of the surgical procedure.
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http://dx.doi.org/10.5137/1019-5149.JTN.23296-18.3DOI Listing
April 2019

Radiological and Surgical Anatomy of Ventral C1-C2 Complex.

Turk Neurosurg 2019 ;29(2):222-228

Dokuz Eylul University, School of Medicine, Department of Anatomy, Izmir, Turkey.

Aim: To evaluate anatomical data of the bony structures during exploration of the C1-C2 complex.

Material And Methods: This study included six formalin-fixed cadaveric head and neck specimens. Radiological images and anatomical measurements included: C1-C2 distance, bony distance between C1 anterior tubercle-nares and superior incisors, height of C1 anterior arch, and height and width of odontoid articular surface.

Results: The mean distance between C1 anterior tubercle-nares and superior incisors on maxilla were 96.16 ± 8.07 mm and 84.14 ± 9.16 mm, respectively. The mean height of C1 anterior arch was 13.89 mm. The meandistance between medial borders of right-left C1 lateral masses was 19.10 ± 1.80 mm. The mean distance between medial border of lateral midline on mass right and left sides were 9.43 ± 0.88 mm and 9.68 ± 0.97 mm, respectively. The mean height of C1 anterior arch at midline was 13.89 ± 2.48 mm, and the mean distance between ventral surface of anterior arch and ventral joint of odontoid at midline was 6.43 ± 1.29 mm. The anteroposterior, horizontal diameters of odontoid on its base were 12.12 ± 0.38 mm, and 11.12 ± 0.94 mm, respectively. The angles of transoral and transnasal approaches to C1 were 32.67 ± 4.59° and 32.00 ± 2.10°, respectively.

Conclusion: A safe transoral or transnasal odontoidectomy requires accurate measurements and imaging regarding ventral C1-C2 relationships, distances of odontoid, lateral mass and midline.
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http://dx.doi.org/10.5137/1019-5149.JTN.23499-18.1DOI Listing
April 2019

Nontraumatic Myositis Ossificans as an Uncommon Cause of Scoliosis: Case Report and Review of the Literature.

World Neurosurg 2019 Mar 18;123:208-211. Epub 2018 Dec 18.

Department of Neurosurgery, Umraniye Teaching and Research Hospital, Istanbul, Turkey.

Background: A 5-year-old pediatric patient developed scoliosis associated with nontraumatic myositis ossificans in the lumbar region. Although there have been reports in literature of syndromes leading to widespread muscle ossifications resulting in shoulder deformities owing to impaired movement in the facet joints, to the best of our knowledge there has been no report of scoliosis associated with myositis ossificans.

Case Description: The case presented is of a 5-year-old girl who developed scoliosis associated with nontraumatic myositis ossificans in the lumbar region. On the thoracolumbar radiograph, a hyperintense lesion was seen at the right-side L2-L3 level and scoliosis with a Cobb angle of 16.2° to the right side. The decision for surgery was made with the consideration of the existing scoliosis and that the complaints were associated with paravertebral calcified lesions adjacent to the facet joints. After surgery, the scoliosis improved.

Conclusions: Nontraumatic, paravertebral myositis ossificans at an early age is a very rare pathology. Therefore, it must be recognized that spine deformities such as scoliosis and kyphosis can develop in neglected cases of paravertebral myositis ossificans. In addition, there is a high risk of confusion with malignant pathologies, such as osteosarcoma, in this area. Removal of the mass eliminates both the pain of myositis ossificans and prevents the development of scoliosis.
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http://dx.doi.org/10.1016/j.wneu.2018.11.259DOI Listing
March 2019

The role of neuronavigation and intraoperative ultrasonography in distal middle cerebral artery aneurysm.

Neurosciences (Riyadh) 2018 Jul;23(3):265-267

Department of Neurosurgery, Healty Science University, Umraniye Teaching and Research Hospital, Istanbul, Turkey. Email:

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http://dx.doi.org/10.17712/nsj.2018.3.20180059DOI Listing
July 2018

Radiologic Anatomy of the Lumbar Interlaminar Window and Surgical Considerations for Lumbar Interlaminar Endoscopic and Microsurgical Disc Surgery.

World Neurosurg 2018 Jul 14;115:e22-e26. Epub 2018 Mar 14.

Department of Neurosurgery, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Turkey. Electronic address:

Objective: The interlaminar window is the most important corridor during both interlaminar approaches to intervertebral discs. The aim of this study was to measure radiologic parameters related to endoscopic and microsurgical interlaminar discectomy.

Methods: Measured parameters included lateral recess line (LRL) width, distance between LRL and endplates of upper intervertebral disc, superior and lateral angles of interlaminar window, interlaminar height, and interpedicular distance via optimized coronal oblique projection computed tomography images. Measurements were performed at L2, L3, L4, and L5 levels.

Results: LRL was found to be 16.3 ± 3.4 mm, 17.3 ± 3.3 mm, 21.7 ± 3.4 mm, and 27.7 ± 4.0 mm at L2, L3, L4, and L5. The distances between LRL and both upper endplates decreased from L2 to L5. Distance between LRL and upper endplate of same vertebra and between LRL and lower endplate of upper vertebra was measured. Interlaminar window height decreased from L2 to L5 levels (from 14.0 ± 4.1 mm to 11.1 ± 2.4 mm).

Conclusions: This study showed that width of LRL increases in lower lumbar segments, and height of interlaminar window increases in upper lumbar segments. This study also revealed that intervertebral disc is located cranial to LRL at L2-3, L3-4, and L4-5 levels and is located caudal to LRL at L5-S1 level. The results of this study may help surgical planning in both endoscopic and microscopic interlaminar surgery.
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http://dx.doi.org/10.1016/j.wneu.2018.03.049DOI Listing
July 2018

Comparison of rigid and semi-rigid instrumentation under acute load on vertebrae treated with posterior lumbar interbody fusion/transforaminal lumbar interbody fusion procedures: An experimental study.

Proc Inst Mech Eng H 2018 Apr 2;232(4):388-394. Epub 2018 Feb 2.

1 Department of Neurosurgery, Ümraniye Training and Research Hospital, Istanbul, Turkey.

Rigid and semi-rigid fixations are investigated several times in order to compare their biomechanical stability. Interbody fusion techniques are also preferable for maintaining the sagittal balance by protecting the disk height. In this study, the biomechanical comparison of semi-rigid and rigid fixations with posterior lumbar interbody fusion or transforaminal lumbar interbody fusion procedures is conducted under trauma. There were four different test groups to analyze the effect of acute load on treated ovine vertebrae. First and second groups were fixed with polyetheretherketone rods and transforaminal lumbar interbody fusion and posterior lumbar interbody fusion cages, respectively. Third and fourth groups were fixed with titanium rods and posterior lumbar interbody fusion and transforaminal lumbar interbody fusion cages, respectively. The drop tests were conducted with 7 kg weight. There were six samples in each group so the drop test repeated 24 times in total. The test samples were photographed and X-rayed (laterally and anteroposteriorly) before and after drop test. Two fractures were observed on group 1. Conversely, there were no fractures observed for group 2. There were no anterior element fractures for both groups 1 and 2. However, one fracture seen on group 3 was anterior element fracture, whereas the other three were posterior element fractures. All three fractures were anterior element fractures for group 4. Treated vertebrae with polyetheretherketone rods and posterior lumbar interbody fusion cages showed the best durability to the drop tests among the groups. Semi-rigid fixation gave better results than rigid fixation according to failed segments. Posterior lumbar interbody fusion cages seem to be better option for semi-rigid fixation, however mentioned surgical disadvantages must be considered.
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http://dx.doi.org/10.1177/0954411918755416DOI Listing
April 2018

Surgical anatomy of neurovascular structures related to ventral C1-2 complex: an anatomical study.

Surg Radiol Anat 2018 May 26;40(5):581-586. Epub 2017 Dec 26.

Department of Neurosurgery, Health Sciences University, Ümraniye Education and Research Hospital, Istanbul, Turkey.

Objective: Transoral odontoidectomy and ventral C1-2 stabilization are important surgical procedures, performed to decompress ventral spinal cord, and to stabilize craniovertebral junction. These procedures require knowledge regarding surgical anatomy of neurovascular structures ventral to the C1-2 complex. The aim of this study is to evaluate the relationships between neurovascular structures and bony landmarks in ventral atlantoaxial complex.

Materials And Methods: This study was performed on six formaldehyde fixed cadaveric head and neck specimens. Relevant anatomical parameters, including distances from the midsagittal line to internal carotid arteries (ICA), vertebral arteries (VA), and hypoglossal nerves (HN), were measured using electronic calipers.

Results: The mean distance between ICA and midsagittal line was observed as 26.13 mm at the level of axis and 24.67 mm at the level of the atlas. The mean distance between VA and midsagittal line was observed as 15.38 mm at the level of axis and 26.54 mm at the level of the atlas. The mean distance between HN and midsagittal line was observed as 33.27 and 33.58 mm at the level of the atlas and axis, respectively.

Conclusion: This study confirmed that ICA and HN proceeded ventrally or laterally along the lateral aspect of the C1 lateral mass; therefore, the area located ventrally along the medial components of the C1 lateral mass was the safe zone for anterior surgical approach.
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http://dx.doi.org/10.1007/s00276-017-1961-5DOI Listing
May 2018

Dural prostate metastasis presenting as a subdural hematoma.

North Clin Istanb 2017 18;4(3):279-282. Epub 2017 Oct 18.

Department of Neurosurgery, Health Sciences University Faculty of Medicine, Umraniye Training and Research Hospital, Istanbul, Turkey.

The incidence of subdural hematoma is approximately 13.1/100.000 per year. Subdural hematoma due to skull and dura mater metastases is rare. In this study, a 71-year-old patient with prostate adenocarcinoma who presented with chronic subdural hematoma due to skull bone and dura mater metastasis is presented.
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http://dx.doi.org/10.14744/nci.2017.47354DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5724927PMC
October 2017

Downward Laminotomy Technique for Hidden Zone Foraminal Disk Herniations: Technical Notes and Preliminary Results.

Clin Spine Surg 2018 05;31(4):152-155

Department of Neurosurgery, Health Sciences University, Umraniye Teaching and Research Hospital, Istanbul, Turkey.

Introduction: Hidden zone foraminal herniations are among the more rare forms of herniations. As exploration is difficult, and there is a close relationship between the nerve root and pedicle, many surgical approaches have been proposed. The aim of this study was to describe downward laminotomy as a new approach to these herniations.

Materials And Methods: A downward laminotomy technique was used in 5 cases with hidden zone foraminal disk herniation with no extension to the intervertebral disk space.

Results: The herniated disk fragment was located at L4-L5 in 4 cases and at L3-L4 in 1 case. Mean visual analog scale scores reduced from preoperative 8.2 to 2.1 postoperatively. The allodynia was resolved in two months.

Conclusions: It was concluded that downward laminotomy provides a safe, less risky, and minimally invasive approach to hidden zone foraminal disk herniations.
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http://dx.doi.org/10.1097/BSD.0000000000000562DOI Listing
May 2018

The radiological distance between the lumbar pedicle and laminar edges.

Surg Radiol Anat 2017 Nov 25;39(11):1249-1252. Epub 2017 May 25.

Department of Neurosurgery, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Turkey.

Introduction: Lumbar foraminal inner zone herniations are challenging cases, for which there are variety of approaches. However, there is no information about the distance between these herniations and the edges of the respective lamina. The aim of this study was to measure the distance between the inferomedial aspect of lumbar pedicles and laminar edges.

Materials And Methods: The lumbar CT images of 30 cases were reviewed. The distances between the edges of the lamina and the inferomedial aspects of the respective pedicles were measured. The study was performed on L3, L4, and L5 lumbar vertebrae on both sides.

Results: The mean distance between the upper edge of the lamina and the inferomedial aspect of the respective pedicle was found to be 10.8 ± 3.5, 11.6 ± 2.4, and 14.1 ± 2.3 mm on the left side, and 11.1 ± 4.4, 12.0 ± 2.5, and 13.8 ± 3.2 mm on the right side of L3, L4, and L5 vertebrae. The mean distance between the inferior edge of the lamina and the inferomedial aspect of the respective pedicle was found to be 23.8 ± 4.2, 19.3 ± 3.5, and 11.6 ± 2.9 mm, on the left side, and 23.9 ± 3.2, 19.1 ± 3.7, and 12.4 ± 2.8 mm on the right side of L3, L4, and L5 vertebrae. There was no statistically significant difference between values of the left and right sides (p > 0.05).

Conclusion: This study revealed that distance between the inferomedial aspect of lumbar pedicles and the superior edge of the same lamina was shorter than the distance between the inferomedial aspect of lumbar pedicles and the inferior edge of the same lamina at L3 and L4 level. It was concluded that this shorter distance could be taken into consideration during surgery on inner zone 1 foraminal herniations.
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http://dx.doi.org/10.1007/s00276-017-1876-1DOI Listing
November 2017

History of Spine Deformity in Turkey.

Turk Neurosurg 2017 ;27(5):842-851

University of Health Sciences, Umraniye Teaching and Research Hospital, Department of Neurosurgery, Istanbul, Turkey.

Spine deformities are among the most important spinal disorders, affecting health-related life quality. Although there are some studies in past centuries, most spine deformity-related studies and research has started in the last century. Many surgical techniques, performed between 1960 and 1990, made scoliosis a touchable pathology. These techniques started with Harrington"s system, wiring techniques, pedicle screw techniques, and all other universal techniques. Anterior and 360 degree techniques contributed to this process. The use of spinal osteotomies, and recent technologies such as magnetic rods, intraoperative neuromonitoring added much to the body of knowledge of literature and improved the outcome. Advancement has not been limited to surgery only and diagnostic advancements had also impact to this process. Surgical techniques performed in the west have been performed soon in our countries. Currently almost all surgical techniques for treatment of spine deformities can be performed in our country. This article reviews historical aspects related to the diagnosis and treatment of spine deformities in Turkey.
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http://dx.doi.org/10.5137/1019-5149.JTN.19250-16.0DOI Listing
April 2018

Morphometric evaluation of the uncinate process and its importance in surgical approaches to the cervical spine: a cadaveric study.

Singapore Med J 2016 Oct 14;57(10):570-577. Epub 2015 Dec 14.

Department of Anatomy, School of Medicine, Dokuz Eylül University, İzmir, Turkey.

Introduction: The uncinate process (UP) has an important role because of its relationship with the vertebral artery and spinal roots. Degenerative diseases cause osteophyte formation on the UP, leading to radiculopathy, myelopathy and vertebral vascular insufficiency, which may require surgical management. This study aimed to evaluate the morphometry of this region to shed light on the anatomy of the UP.

Methods: Morphometric data was obtained from 13 male formaldehyde-fixed cadavers. Direct measurements were obtained using a metal caliper. Computed tomography (CT) morphometry was performed with the cadavers in the supine position.

Results: Direct cadaveric measurements showed that the height of the UP increased from C3 (5.8 ± 1.0 mm) to C7 (6.6 ± 0.5 mm). On CT, the corresponding measurements were 5.9 ± 1.2 mm at C3 and 6.9 ± 0.6 mm at C7. The distance between the left and right apex of the UP from C3 to C7 also increased on both direct cadaveric and CT measurements (C3: 20.8 ± 1.0 mm and C7: 28.1 ± 2.4 mm vs. C3: 23.7 ± 3.4 mm and C7: 29.0 ± 3.0 mm, respectively). On CT, the distance between the UP and superior articular process at the C3 to C7 levels were 9.8 ± 1.7 mm, 7.9 ± 1.8 mm, 7.9 ± 1.6 mm, 7.8 ± 1.3 mm and 8.2 ± 1.7 mm, respectively.

Conclusion: Direct cadaveric and CT measurements of the UP are useful for preoperative evaluation of the cervical spine and may lead to better surgical outcomes.
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http://dx.doi.org/10.11622/smedj.2015193DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5075958PMC
October 2016

Where Is Anterior Cervical Discectomy and Fusion Located on the Scott Parabola?

Authors:
Sait Naderi

World Neurosurg 2016 08 17;92:535-536. Epub 2016 Jun 17.

Department of Neurosurgery Health Sciences University, Umraniye Egitim ve Arastirma Hospital, Umraniye, Istanbul, Turkey. Electronic address:

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http://dx.doi.org/10.1016/j.wneu.2016.06.043DOI Listing
August 2016

Alternatives to surgical approach for giant spinal schwannomas.

Neurosciences (Riyadh) 2016 Jan;21(1):30-6

Department of Neurosurgery, Umraniye Teaching and Research State Hospital, Istanbul, Turkey. E-mail:

Objective: To review the diagnoses and surgical approach characteristics of giant spinal schwannomas (GSS) patients.

Methods: We reviewed the preoperative and postoperative radiological and clinical data, and the surgical aspects of 18 GSS patients who underwent surgery in the Department of Neurosurgery, Umraniye Teaching Hospital and Research State Hospital, Istanbul, Turkey between January 2008 and December 2013.

Results: There were 15 (83.3%) female and 3 (16.6%) male patients. The age range was 16-70 years (average: 45.8). Average symptom duration was 1.5 months (range: 1-48). There was local pain in 15 cases, and radicular pain in 6 cases. The GSSs were most frequently located in the lumbosacral area (11 cases, 61.1%). An extraforaminal surgical approach was employed in 7 cases, a posterior approach was employed in 6 cases, a combined anterior transabdominal and posterior approach was employed in 2 cases, a combined posterior and extraforaminal approach was employed in 2 cases, and a retroperitoneal approach was applied in one case. The tumors were completely excised in all cases. The mean follow-up period was 38.5 months (range: 20-68).

Conclusion: Giant spinal schwannomas exhibit unique diagnostic and surgical factors. The selection of an appropriate approach significantly influences the success of the treatment.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5224408PMC
http://dx.doi.org/10.17712/nsj.2016.1.20150242DOI Listing
January 2016