Publications by authors named "Selim Kayacı"

30 Publications

  • Page 1 of 1

Effect of clival bone growth on the localization of the abducens nerve at the petroclival region: a postmortem anatomical study.

Surg Radiol Anat 2021 Mar 9. Epub 2021 Mar 9.

Department of Biostatistics, University of Erzincan Binali Yildirim School of Medicine, Erzincan, Turkey.

Purpose: To investigate the effect of the clival bone pattern on the abducens nerve (AN) localization in the petroclival region between the Pediatric and Adult Groups.

Methods: This study used 12 pediatric and 17 adult heads obtained from the autopsy. The length and width of the clivus and the length of the petrosphenoidal ligaments (PSLs) were measured. The ratio of the length and width of the clivus was accepted as the clival index (CI). The localization of the AN at the petroclival region below the PSL, classified as lateral and medial, were recorded.

Results: The average length of the clivus was 26.92 ± 2.88 mm in the Pediatric Group, and 40.66 ± 4.17 mm in the Adult Group (p < 0.001). The average width of the clivus was 22.35 ± 2.88 mm in the Pediatric Group, and 29.96 ± 3.86 mm in the Adult Group (p < 0.001). The average value of the CI was 1.20 in the Pediatric Group and 1.36 in the Adult Group (p = 0.003). The length of the PSL was 7.0 ± 1.47 mm in the Pediatric Group and 11.05 ± 2.95 mm in the Adult Group (p < 0.001). The nerve was located below the medial side of the PSL in the Pediatric Group and below the lateral side in the Adult Group (p = 0.002).

Conclusions: The petrous apex localization of the AN in adults compared with pediatric subjects could be related to the increased growth in the length of the clivus than its width.
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http://dx.doi.org/10.1007/s00276-021-02691-zDOI Listing
March 2021

Artifacts in cranial MRI caused by extracranial foreign bodies and analysis of these foreign bodies.

Indian J Radiol Imaging 2019 Jul-Sep;29(3):299-304. Epub 2019 Oct 30.

Department of Biostatistics, Faculty of Medicine, Erzincan University, Erzincan, Turkey.

Purpose: The purpose of our study was to conduct a chemical analysis of extracranial foreign bodies (FBs) causing artifacts in cranial magnetic resonance imaging (MRI) and to investigate the association between chemical composition, magnetic susceptibility, and artifact size.

Materials And Methods: A total of 12 patients were included in the study. The FBs responsible for the artifacts were visualized using cranial computed tomography (CT). Artifact-causing FBs were removed from the scalps of 10 patients and analyzed using scanning electron microscope with energy dispersive spectroscopy (SEM-EDS), X-ray diffraction spectroscopy (X-RD), and Fourier-transform infrared spectroscopy (FT-IR). The magnetic susceptibility of the samples was determined using the reference standard material MnCl.6HO. The volume of the MRI artifacts was measured in cubic centimeters (cm).

Results: EDS results demonstrated that the mean Fe ratio was 5.82% in the stone samples and 0.08% in the glass samples. Although no phase peaks were detected in the X-RD spectra of the glass samples, peaks of FeO, AlCa (SiO) were detected in the X-RD spectra of the stone samples. The FT-IR spectra revealed metal oxide peaks corresponding to Fe, Al, in the stone samples and peaks confirming AlSiO and NaSiO structures in the glass samples. The mean volumes of the MRI artifacts produced by the stone and glass samples were 5.9 cm and 2.5 cm, respectively.

Conclusions: Artifacts caused by extracranial FBs containing metal/metal oxide components are directly associated with their chemical composition and the artifact size are also related to element composition and magnetic susceptibility.
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http://dx.doi.org/10.4103/ijri.IJRI_211_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6857268PMC
October 2019

Relationship between subarachnoid and central canal hemorrhage and spasticity: A first experimental study.

J Spinal Cord Med 2019 Oct 24:1-9. Epub 2019 Oct 24.

Department of Pathology, Medical Faculty of Ataturk University , Erzurum , Turkey.

Spastic disorders are considered as important cerebral complications of subarachnoid hemorrhage (SAH). However, there has been no research concerning the pathophysiological mechanism of its link with the spinal cord. The present study aimed to assess the relationship between the development of spasticity and neuronal degeneration after SAH and increase in spinal cord pressure after central canal hemorrhage (CCH). Twenty-three rabbits were included. Of all rabbits, 5, 5, and 13 were allocated in the control, SHAM and study groups, respectively. Moreover, 1 cc of saline and 1 cc of autologous arterial blood were injected into the cisterna magna of the SHAM and study groups, respectively. The Muscle spasticity tension values (MSTVs) were determined according to the modified Ashworth scale. Degenerated neuron densities (DND) in the gray matter (GM) of each animal's spinal cord were stereologically calculated. The average MSTV of each group was as follows: control group (n = 5) 2; SHAM group (n = 5) 3-5; and study group (n = 13) 8-10. The DND values of the spinal cord of each group were as follows: control group, 2 ± 1/mm; SHAM group, 12 ± 3/mm; and study group, 34 ± 9/mm. Results showed an important linear relationship between the MSTVs and the DND of the spinal cord (P < 0.001). Spasticity may be attributed to other causes such as ischemic neurodegenerative process that develops after spinal SAH and the de-synchronization of the flexor-extensor muscles due to the spontaneous discharge of interneuronal structures, which are crossed within the spinal cord owing to the build-up of pressure after CCH.
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http://dx.doi.org/10.1080/10790268.2019.1669956DOI Listing
October 2019

Effect of Vasa Vasorum on Basilar Artery Vasospasm Following Subarachnoid Hemorrhage.

World Neurosurg 2019 Nov 23;131:e218-e225. Epub 2019 Jul 23.

Department of Pathology, School of Medicine, Firat University, Elazig, Turkey.

Background: A well-documented association exists between the vasa vasorum and vasopathologies, including atherosclerosis. However, information on the role of the vasa vasorum during vascular degenerative changes of vasospasm after subarachnoid hemorrhage (SAH) is insufficient.

Methods: In this study, 34 rabbits were divided into 3 groups: basal group (N = 8), sham group (N = 8), and SAH group (N = 18). Experimental SAH was formed using a double-injection model. During follow-up, the neurologic status of the rabbits was observed. All rabbits were euthanized after 2 weeks, and the vasopathologic degeneration was categorized as normal, mild, moderate, and severe according to the changes in the basilar arteries. The numbers, locations, and spasms of the vasa vasorum and their relation to the vasodegenerative changes of the basilar artery were investigated.

Results: The basilar arteries were graded as normal in the basal and sham groups. In the SAH group, 6 rabbits had mild, 7 had moderate, and 5 had severe degeneration. Neurologic deficits were prominent in the SAH group, and deficit grades correlated with vascular degeneration. The number of the vasa vasorum were significantly higher in the SAH group, and an enhanced formation of the vasa vasorum was noted in which severe degenerative changes were present. Moreover, the vasospasm index of the vasa vasorum, which increased with the aggravation of vascular degenerative changes, was significantly higher in the SAH group.

Conclusions: The vasa vasorum and their vasospasm play a crucial role in the pathogenesis of basilar artery degeneration in the vasospasm following SAH.
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http://dx.doi.org/10.1016/j.wneu.2019.07.124DOI Listing
November 2019

Aortic Injury by Thoracic Pedicle Screw. When Is Aortic Repair Required? Literature Review and Three New Cases.

World Neurosurg 2019 Aug 9;128:216-224. Epub 2019 May 9.

Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara, Turkey.

Purpose: Aortic injury by pedicle screw is rare but can cause serious complications. It has not been clearly determined when aortic repair is necessary in cases of screw impingement without perforation of the aortic wall. In this article, we review the treatment and clinical course of pedicle screw aortic impingement and attempt to clarify this issue.

Methods: Cases of aortic injury during thoracic screw procedures were found using a MEDLINE search and analyzed together with 3 new cases that we present.

Results: Nineteen cases collected from the literature and 3 new cases were included in the study. In 7 of the cases, aortic impingement by the pedicle screw was detected during postoperative follow-up (day 1) radiologic examinations. In the other cases, time to presentation of aortic impingement ranged between 2 weeks and 60 months after fixation. The main indications for thoracic spinal fixation were post-traumatic vertebral fracture and kyphoscoliosis/scoliosis. Repair of the aortic damage ranged from primary repair to stent and tube graft placement by the thoracic endovascular aortic repair method.

Conclusions: In cases in which the screw impinges less than 5 mm into the aortic wall, hardware revision without aortic repair may be sufficient if recognized early and there are no sign of aortic leakage in vascular imaging. However, cases with more than 5 mm of screw impingement should undergo aortic repair first, even in the absence of aortic leakage, following by screw revision.
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http://dx.doi.org/10.1016/j.wneu.2019.04.173DOI Listing
August 2019

A comparison of lateral ventricle volume estimation on magnetic resonance and cadaveric section images using the planimetry method.

J Clin Neurosci 2019 06 5;64:264-268. Epub 2019 Apr 5.

Department of Anatomy, Faculty of Medicine, Karabük University, Karabük, Turkey. Electronic address:

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http://dx.doi.org/10.1016/j.jocn.2019.03.046DOI Listing
June 2019

Brachial Artery Vasospasm Caused by Cervical Dorsal Root Ganglion Degeneration After Subarachnoid Hemorrhage: An Experimental Study.

World Neurosurg 2019 Jun 11;126:e895-e900. Epub 2019 Mar 11.

Department of Pathology, Medical Faculty of Ataturk University, Erzurum, Turkey.

Purpose: Subarachnoid hemorrhage (SAH) may lead to vasospasm in various vessels. The cervical nerves have a vasodilatory effect on the upper extremity arteries. The aim of this study was to investigate if there is a relationship between C6 dorsal root ganglion (DRG) degeneration and brachial artery (BA) vasospasm after spinal SAH.

Methods: This experimental study was conducted on 23 rabbits. The animals were divided into 3 groups: control (n = 5), SHAM (n = 5), and study group (n = 13). One cubic centimeter (cc) of serum saline was injected into the cisterna magna of animals of the SHAM group; the same procedure was performed by 1 cc of homologous blood in the study group. Degenerated neuron densities (DNDs) of DRGs (n/mm) at C6 levels and BA vasospasm indexes (VSI; wall surface/lumen surface) of all animals were determined and results were analyzed statistically.

Results: Mean VSI values of BAs and DNDs of CDRGs of the control, SHAM, and study groups were estimated as 10 ± 3/1.12 ± 0.11 n/mm, 34 ± 9/1.27 ± 0.24 n/mm, and 1031 ± 145/2.93 ± 0.78 n/mm, respectively. Mean DNDs and VSI values were statistically significantly different between the control and study groups (P < 0.0001).

Conclusions: CDRG degeneration may be considered as an important factor in the etiopathogenesis of severe BA vasospasm after SAH.
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http://dx.doi.org/10.1016/j.wneu.2019.03.007DOI Listing
June 2019

A New Neuropathologic Mechanism of Blood pH Irregularities After Neck Trauma: Importance of Carotid Body-Glossopharyngeal Nerve Network Degeneration.

World Neurosurg 2019 05 11;125:e972-e977. Epub 2019 Feb 11.

Department of Biochemistry, Erzurum Research-Training Hospital, Erzurum, Turkey.

Objective: We created a neck trauma model by injecting blood into the sheath of rabbits' carotid bodies (CBs). Then we determined the relationship between neuronal degeneration of the CB due to hemorrhage of this organ and its clinical effects such as blood pH and heart rhythm.

Methods: The present study included 24 adult male New Zealand rabbits. The animals were divided into 3 groups: control (n = 5); sham (0.5 mL saline injected into CBs; n = 5); and study (CB trauma model; n = 14). pH values and heart rhythms were recorded before the experiment to determine the values under normal conditions, and measurements were repeated thrice in the days following the experiment. The number of normal and degenerated neuron density of CBs was counted. The relationship between the blood pH values, heart rhythms, and degenerated neuron densities was analyzed.

Results: Heart rhythms were 218 ± 20 in the control group, 197 ± 16 in the sham group (P = 0.09), and 167 ± 13 in the study group (P < 0.0005). pH values were 7.40 ± 0.041 in the control group, 7.321 ± 0.062 in the sham group (P = 0.203), and 7.23 ± 0.02 in study group (P < 0.0005). Degenerated neuron densities were 12 ± 4/mm in the control group, 430 ± 74/mm in the sham group (P < 0.005), and 7434 ± 810/mm in the study group (P < 0.0001).

Conclusions: A high degenerate neuron density in the CB can decrease blood pH and hearth rhythm after neck trauma, and there might be a close relationship between the number of degenerated neurons and clinical findings (such as heart rhythm and blood pH). This relationship suggests that injury to the glossopharyngeal nerve-CB network can cause acidosis by disturbing the breathing-circulating reflex and results in respiratory acidosis.
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http://dx.doi.org/10.1016/j.wneu.2019.01.218DOI Listing
May 2019

Comparison of Thalamus Volume on Magnetic Resonance and Cadaveric Section Images.

Turk Neurosurg 2020 ;30(4):491-500

Erzincan Binali Yildirim University, Faculty of Medicine, Department of Neurosurgery, Erzincan, Turkey.

Aim: To measure and to compare the volume of thalamus using magnetic resonance imaging (MRI) and the anatomical sections.

Material And Methods: In this study, 13 brain specimens were used. First, the images were taken in 3 mm sections on MRI, the thickness of the thalamus was measured. Subsequently, 4 mm coronal sections were prepared using a microtome. The thalamic volumes calculated from cadaveric specimens were compared with the measurements obtained using MRI.

Results: On MRI, the mean thalamic volumes on the right and left hemispheres were found to be 5843.4 ± 361.6 mm3 and 5377.0 ± 666.2 mm3 respectively. The mean volumes of the cadaveric sections were 5610.8 ± 401.3 mm3 on the right side and 5618.5 ± 604.1 mm3 on the left hemisphere. No statistically significant difference was found between the volume calculated from MRI and that obtained from the cadaveric section (p < 0.05).

Conclusion: This study shows a correlation between measurement of thalamus volume based on MRI and those calculated from anatomical sections. Our findings support the reliability of DBS procedures using MRI and stereotactic method.
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http://dx.doi.org/10.5137/1019-5149.JTN.24530-18.2DOI Listing
November 2020

Long-Term Outcomes of a New Minimally Invasive Approach in Chiari Type 1 and 1.5 Malformations: Technical Note and Preliminary Results.

World Neurosurg 2018 07 24;115:407-413. Epub 2018 Apr 24.

Department of Radiology, Istanbul Training and Research Hospital, Istanbul, Turkey.

Background: The treatment options for patients with Chiari malformation type 1 (CM1) and Chiari malformation type 1.5 (CM1.5) have not yet been standardized. In these malformations, the main factors include obstruction at the level of the foramen magnum and dural and ligamentous thickening. Here we present our outcomes of surgery and decompression using a minimally invasive surgery (MIS) technique.

Methods: Sixty-one patients admitted to our clinics between 2009 and 2016 due to CM1 or CM1.5 and who had undergone MIS were investigated retrospectively. All patients were followed up for a mean period of 55 months, both clinically and radiologically, and the outcomes were recorded.

Results: All 61 patients underwent foramen magnum decompression through a 1.5-cm mini-open incision, C1 laminectomy and C2 medial inner side tour, posterior atlanto-occipital membrane removal, external dural delamination, and widening of the internal dura with longitudinal incisions. Fifty-six patients (91.8%) were satisfied with the outcome, 4 patients (6.5%) remained the same, and 1 patient (1.6%) reported a poor outcome. Forty-five percent of the patients with syringomyelia demonstrated resolution within 2 years, and 92% demonstrated resolution in 5 years. Scoliosis was seen in 5 patients (8.1%). The rate of benefit from the surgical procedure was statistically significant (P = 0.0045), and no patient required additional surgery because of poor decompression.

Conclusions: MIS is effective for uncomplicated cases of CM1 and CM1.5 due to its minimal connective and muscular tissue damage, short surgical duration, short recovery time, early mobilization, effective posterior foramen magnum widening, lack of liquor fistula development, and better clinical and radiologic improvement during long-term follow-up.
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http://dx.doi.org/10.1016/j.wneu.2018.04.100DOI Listing
July 2018

Petrobasilar, petroclival or petrosphenoidal canal of the abducens nerve.

Acta Neurochir (Wien) 2017 11 24;159(11):2145-2146. Epub 2017 Sep 24.

Faculty of Medicine, Department of Neurosurgery, Erzincan University, Erzincan, Turkey.

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http://dx.doi.org/10.1007/s00701-017-3324-8DOI Listing
November 2017

Unexpected Rupture of a Giant Lobulated Thrombotic Middle Cerebral Artery Aneurysm and Emergency Surgical Treatment With Thrombectomy: A Case Report and Review of the Literature.

Iran Red Crescent Med J 2016 Aug 13;18(8):e30608. Epub 2016 Jun 13.

Department of Neurosurgery, Medical School, Recep Tayip Erdogan University, Rize, Turkey.

Introduction: The treatment of giant intracranial aneurysms is one of the most challenging cerebrovascular problems of neurosurgery. We report the rupture of a giant, lobulated, and almost completely thrombosed middle cerebral artery (MCA) aneurysm that is the ninth such report in the literature. We also investigated additional solutions used in the treatment of this patient.

Case Presentation: A 58-year-old man had been admitted with headache 8 years previously (in 2005), and a giant MCA aneurysm was detected. Two separate endovascular interventions were performed, and both failed. The patient began to live with the giant aneurysm. As there was a large thrombosis filling the aneurysm lumen during the previous endovascular procedures, the aneurysm was not expected to rupture. However, a rupture eventually occurred, in 2013. Even if an aneurysm is very large, lobulated, old, and almost completely thrombosed, it can suddenly bleed. During surgery on this patient, we observed severe cerebral vasospasm caused by a giant thrombosed aneurysmal rupture. Despite the complications, surgery is a life-saving treatment for this emergency when other strategies are not possible. Thrombectomy and clipping are approaches that require a great deal of courage for the neurosurgeon, in terms of entering the risky area within the aneurysm.

Conclusions: We believe that it would be more appropriate to plan for combined treatment with surgical and endovascular approaches before the emergency condition could occur.
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http://dx.doi.org/10.5812/ircmj.30608DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5065920PMC
August 2016

Split Rib Cranioplasty for Frontal Osteoma: A Case Report and Review of the Literature.

Iran Red Crescent Med J 2016 Jul 4;18(7):e29541. Epub 2016 Jan 4.

Department of Pathology, Medical School, Recep Tayip Erdogan University, Rize, Turkey.

Introduction: Osteomas are benign bone tumors. They generally lead to a local thickness on the frontal bone in calvarium. When they occur on the forehead, they often cause a cosmetic disorder without any neurological symptoms. The significant problem is the repair method of the cranium defect.

Case Presentation: The rib of a 34-year-old female was split and used for a small cranium defect of 3 × 3.5 cm. The preferred method and the obtained results were presented under the guidance of the literature.

Conclusions: Along with the technological advancement, different materials are employed according to the size of the cranium defect and the age of the case. The application of split costa cranioplasty for the small cranium defects in the region of patient's face is the method with the least possibility of complications, and its cosmetic and functional results are quite promising.
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http://dx.doi.org/10.5812/ircmj.29541DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5026782PMC
July 2016

Reduction and arthrodesis with sublaminar spiral silk in atlantoaxial joint instability.

Acta Orthop Traumatol Turc 2014 ;48(4):443-8

Department of Neurosurgery, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey.

Objective: The aim of this study was to evaluate the clinical and radiologic results of the use of thick spiral silk knotting instead of sublaminar wiring for C1-C2 arthrodesis in patients with atlantoaxial instability.

Methods: We retrospectively evaluated 16 patients (10 females, 6 males; mean age: 43.4 years; mean follow-up: 34 months) with atlantoaxial instability who underwent C1-C2 fusion by reduction and sublaminar spiral silk knotting. All patients underwent open reduction, bounding both laminae with thick spiral silk instead of wiring and arthrodesis with autografting. Reduction rates, screw position and fusion rates were evaluated using computed tomography.

Results: Preoperative mean atlantodental interval (ADI) was 8 (range: 6 to 11) mm and postoperative ADI was 2.1 (range: 0.5 to 2.5) mm. There was no dural or spinal cord injury. Complete reduction was observed in all cases. Fusion was unsuccessful in 1 case (6.25%). Postoperative mean flexion ADI was 10 mm and mean extension ADI was 1 mm. Graft separation between C1-C2 was observed in slice tomographic examination in one patient. Malposition was observed in 2 screws (4%).

Conclusion: The sublaminar silk knotting technique appears to provide safe anatomical reduction. As this method is cheap and simple and does not require extra implantation, loosen, create neurologic compromise or cause radiologic crowding, it can be considered an alternative surgical technique to sublaminar wiring.
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http://dx.doi.org/10.3944/AOTT.2014.3156DOI Listing
November 2015

Long term results of lumbar sequestrectomy versus aggressive microdiscectomy.

J Clin Neurosci 2014 Oct 2;21(10):1714-8. Epub 2014 Jun 2.

T.C. Rize Tayyip Erdoğan University, Rize Merkez, Rize, Turkey.

It remains unknown whether aggressive microdiscectomy (AD) provides a better outcome than simple sequestrectomy (S) with little disc disruption for the treatment of lumbar disc herniation with radiculopathy. We compared the long term results for patients with lumbar disc herniation who underwent either AD or S. The patients were split into two groups: 85 patients who underwent AD in Group A and 40 patients who underwent S in Group B. The patients were chosen from a cohort operated on by the same surgeon using either of the two techniques between 2003 and 2008. The demographic characteristics were similar. The difference in complication rates between the two groups was not statistically significant. During the first 10 days post-operatively, the Visual Analog Scale score for back pain was 4.1 in Group A and 2.1 in Group B, and the difference was statistically significant (p<0.005). The Oswestry Disability Index score was 11% in Group A and 19% in Group B at the last examination. The reherniation rate was 1.5% in Group A and 4.1% in Group B (p<0.005). We argue that reherniation rates are much lower over the long term when AD is used with microdiscectomy. AD increases back pain for a short time but does not change the long term quality of life. To our knowledge this is the first study with a very long term follow-up showing that reherniation is three times less likely after AD than S.
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http://dx.doi.org/10.1016/j.jocn.2014.01.012DOI Listing
October 2014

The role of sympathectomy on the regulation of basilar artery volume changes in stenoocclusive carotid artery modeling after bilateral common carotid artery ligation: an animal model.

Acta Neurochir (Wien) 2014 May 21;156(5):963-9. Epub 2014 Feb 21.

Department of Neurosurgery, Bagcilar Medicine Hospital, Bagcilar, Istanbul, Turkey,

Background: Stenoocclusive carotid artery disease causes important histomorphologic changes in all craniocervical vasculatures, such as luminal enlargement, vascular wall thinning, elongation, convolutions, and aneurysm formation in the posterior circulation. Although increased pressure, retrograde blood flow, and biochemical factors are described in the pathogenesis of vascular remodelisation, the vasoregulatory role of the autonomic nervous system has not been investigated thus far. We investigated the relationship between the sympathetic nervous system and the severity of histomorphologic alterations of basilar arteries after bilateral common carotid artery ligation (BCCAL).

Material And Methods: This study was conducted on 21 rabbits. The rabbits were randomly divided into three groups: baseline group (n = 5), sympathectomy non-applied group (SHAM; n = 8), and sympathectomy applied group (n = 8) before bilateral common carotid artery ligation. Permanent ligation of the prebifurcations of the common carotid arteries was performed to replicate stenoocclusive caroid artery disease. Basilar artery volumes were measured after ligation. Volumes of the basilar arteries were estimated by stereologic methods and compared between groups.

Results: Luminal enlargement, wall thinning, elongation, convolutions, and doligoectatic configurations were detected in the majority of basilar arteries. The mean basilar arterial volume was 4.27 ± 0.22 mm3 in the baseline group; 5.28 ± 0.67 mm(3) in the SHAM group, and 8.84 ± 0.78 mm3 in the study group. The severity of basilar enlargement was significantly higher in the study group compared with the SHAM (p < 0.005) and baseline groups (p < 0.001).

Conclusions: Sympathectomy causes basilar artery enlargment, which is beneficial for maintaining cerebral blood flow; however, it also causes wall thinning, elongation, convolution, and aneurysm formation, which may be hazardous in stenoocclusive carotid artery disease. Sympathectomy can prevent new vessel formation and hyperthyrophic changes at the posterior circulation. Neovascularisation is not detected adequately in sympathectomised animals.
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http://dx.doi.org/10.1007/s00701-014-1994-zDOI Listing
May 2014

In reply.

Authors:
Selim Kayaci

Clin Neurol Neurosurg 2014 Apr 29;119:133-4. Epub 2014 Jan 29.

Recep Tayyip Erdogan University, Medicine Faculty, Rize, Turkey. Electronic address:

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http://dx.doi.org/10.1016/j.clineuro.2014.01.026DOI Listing
April 2014

Effect of inner membrane tearing in the treatment of adult chronic subdural hematoma: a comparative study.

Neurol Med Chir (Tokyo) 2014 28;54(5):363-73. Epub 2014 Jan 28.

Department of Neurosurgery, Recep Tayyip Erdogan University.

The postoperative results of chronic subdural hematoma (CSDH) procedures using catheterization and tearing of inner membrane (CTIM) technique have not previously been discussed in the literature. This article compares the effects of CTIM technique on brain re-expansion and re-accumulation with cases operated on with a burr-hole craniotomy and outer membrane incision (BCOMI) technique. The study involved operations on 144 patients (Group 1) using the CTIM technique and 108 patients (Group 2) using the BCOMI technique. In the operations using the CTIM technique in Group 1, the mean effusion measured in the subdural space (SDS) was 10.0 ± 0.2 mm, and for Group 2, 14.3 ± 0.6 mm in the postoperative period on the first and third days and this difference was found to be significant (p < 0.05). The means were 6.6 ± 0.2 mm for Group 1 and 10.3 ± 0.5 mm for Group 2 on the seventh day (p < 0.05). Recurrence rate was 8.3% in Group 2 and 0 in Group 1. This difference was statistically significant (p = 0001). The length of hospital stay was 7.0 ± 0.1 days for the Group 1 and 8.8 ± 0.2 days for Group 2 and this difference was significant (p < 0.05). These results indicate that the CTIM technique is preferable because it results in earlier re-expansion, lower recurrence, less subdural effusion and pneumocephalus, and shorter hospital stays.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4533437PMC
http://dx.doi.org/10.2176/nmc.oa.2013-0147DOI Listing
August 2015

New practical landmarks to determine sigmoid sinus free zones for suboccipital approaches: an anatomical study.

J Craniofac Surg 2013 ;24(5):1815-8

From the *Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara; †Faculty of Medicine, Ankara University, Ankara; ‡Department of Neurosurgery, Faculty of Medicine, Pamukkale University, Denizli; §Department of Neurosurgery, Faculty of Medicine, Recep Tayyip Erdogan University, Rize; and ∥ Department of Anatomy, Faculty of Medicine, Ankara University, Ankara, Turkey.

Literature defines the landmarks to identify the courses and locations of the transverse and sigmoid sinuses on the outer surface of the skull and inner surface of the scalp. These natural landmarks may only be helpful after skin incision and are inadequate to determine the length and size of the skin incision. Still, there is a need to identify palpable landmarks easily to determine the ideal location to open the initial burr hole before an operation. Twenty-eight dried adult human skulls and 2 cadavers were evaluated. The zygomatic root, the inion, and the mastoid process were identified on the external, and the grooves for sigmoid and transverse sinuses, on the internal surfaces. The distances between the 3 landmarks and the midpoints, and the shortest distances of the midpoints to the border of the groove for sigmoid sinus and groove for transverse sinus were measured. Statistically significant differences were evaluated for both sides. Based on the measurements, the defined "artificial landmarks" can be considered safe points that involve no vascular structures and may be used to perform the initial burr hole during posterolateral approaches. Identification of the midpoints and palpation of the defined landmarks easily before the operation render the study feasible and practical unlike with natural landmarks. To avoid venous injury, the midpoints of mastoid-inion line and zygomatic root-inion line can be used safely in skin incision during posterior fossa approaches and craniotomy.
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http://dx.doi.org/10.1097/SCS.0b013e3182997ff8DOI Listing
September 2014

Importance of the perforating arteries in the proximal part of the PICA for surgical approaches to the brain stem and fourth ventricle--an anatomical study.

Clin Neurol Neurosurg 2013 Oct 12;115(10):2153-8. Epub 2013 Aug 12.

Department of Neurosurgery, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey. Electronic address:

Objective: The purpose of this study is to examine the perforating arteries (PAs) in the proximal part of the posterior inferior cerebellar artery (PICA) for surgical approaches to the brain stem and fourth ventricle, and to stress their importance in microsurgical procedures.

Methods: Twenty-six adult cadaver obtained from routine autopsies were used. During the examination, the PAs and the segmental structure of the proximal part of the PICAs and their relation to the neighbouring anatomical structures were demonstrated.

Results: We classified the PICAs into 4 types on the basis of the distance of the middle point of the width of the caudal loop to the midline, and their presence or absence as Group A (symmetrical, anterior medullary type: 26.9%), Group B (lateral medullary type: 15.4%), Group C (asymmetrical type: 38.5%), and Group D (unilateral type: 19.2%). The number of the PAs in the tonsillomedullary segment and the caudal loop was higher than those originating from the other segments.

Conclusions: Approaches to the medial or lateral of the PICA should be made in a way that protects the PAs (avoiding retraction of the PICA). Otherwise the PAs will be damaged and as a result brain stem ischaemia may occur, which can have serious clinical outcomes.
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http://dx.doi.org/10.1016/j.clineuro.2013.08.005DOI Listing
October 2013

Primary osteoma of the orbit with atypical facial pain: case report and literature review.

Turk Neurosurg 2012 ;22(3):389-92

Sar Hospital, Department of Neurosurgery, Rize, Turkey.

Osteoma is a benign, slowly growing tumor that mainly occurs in the bones and cavities of the middle third of the face, representing the most frequent benign tumor of the paranasal sinuses. It rarely originates primarily from the orbit. Most of these lesions develop in the fourth to fifth decades of life, and are more commonly encountered in males. In the English literature, there are so far three reported cases of primary osteoma of the orbit that originated from the sphenoid bone. Here we present another case of a primary osteoma of the orbit presenting with atypical facial pain and discuss the relevant literature.
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http://dx.doi.org/10.5137/1019-5149.JTN.3690-10.0DOI Listing
November 2012

Posterior transodontoid fixation: A new fixation (Kotil) technique.

J Craniovertebr Junction Spine 2011 Jan;2(1):41-5

Department of Neurosurgery, Istanbul Educational and Research Hospital, Istanbul, Turkey.

Anterior odontoid screw fixation or posterior C1-2 fusion techniques are routinely used in the treatment of Type II odontoid fractures, but these techniques may be inadequate in some types of odontoid fractures. In this new technique (Kotil technique), through a posterior bilateral approach, transarticular screw fixation was performed at the non-dominant vertebral artery (VA) side and posterior transodontoid fixation technique was performed at the dominant VA side. C1-2 complex fusion was aimed with unilateral transarticular fixation and odontoid fixation with posterior transodontoid screw fixation. Cervical spinal computed tomography (CT) of a 40-year-old male patient involved in a motor vehicle accident revealed an anteriorly dislocated Type II oblique dens fracture, not reducible by closed traction. Before the operation, the patient was found to have a dominant right VA with Doppler ultrasound. He was operated through a posterior approach. At first, transarticular screw fixation was performed at the non-dominant (left) side, and then fixation of the odontoid fracture was achieved by directing the contralateral screw (supplemental screw) medially and toward the apex. Cancellous autograft was scattered for fusion without the need for structural bone graft or wiring. Postoperative cervical spinal CT of the patient revealed that stabilization was maintained with transarticular screw fixation and reduction and fixation of the odontoid process was achieved completely by posterior transodontoid screw fixation. The patient is at the sixth month of follow-up and complete fusion has developed. With this new surgical technique, C1-2 fusion is maintained with transarticular screw fixation and odontoid process is fixed by concomitant contralateral posterior transodontoid screw (supplemental screw) fixation; thus, this technique both stabilizes the C1-2 complex and fixes the odontoid process and the corpus in atypical odontoid fractures, appearing as an alternative new technique among the previously defined C1-C2 fixation techniques in eligible cases.
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http://dx.doi.org/10.4103/0974-8237.85313DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3190430PMC
January 2011

Role of neuron density of the stellate ganglion on regulation of the basilar artery volume in subarachnoid hemorrhage: An experimental study.

Auton Neurosci 2011 Dec 25;165(2):163-7. Epub 2011 Aug 25.

Department of Neurosurgery, Medical Faculty of Rize University, Rize, Turkey.

Background: The role of neuron density (of the stellate ganglion) in basilar artery vasospasm after subarachnoid hemorrhage (SAH) has not previously been investigated. This subject was studied.

Methods: This study was conducted on 24 rabbits. Four of them were used as the baseline control group. Experimental SAH was applied to the 15 animals; the remaining five of them were used as a sham group injecting by the serum physiologic saline (PS) and followed up twenty days later. Stellate ganglion neuron densities were estimated stereologically. Vasospasm index (VSI) was used to assess the severity of vasospasm. The value of VSI between 1 and 1.5 was accepted as no vasospasm, 1.5-2 was accepted as light vasospasm and 2 or greater than 2 was accepted as severe vasospasm. Results were compared statistically.

Results: The mean basilar artery VSI in the control group (n: 4) was calculated as 1.24±0.39 and the neuron density of stellate ganglion was calculated as 8320±675/mm(3). These values in the PS group (n: 5) were calculated as 1.26±0.37 and 8380±680/mm(3). In animals with light basilar artery vasospasm (n: 6), the basilar artery VSI and neuron density of stellate ganglion were 1.65±0.37, 9210±460/mm(3) consecutively, but the basilar artery VSI was 2.07±0.40 and neuron density was 12,075±950/mm(3) in animals with severe vasospasm (n: 9).

Conclusion: The neuron density of stellate ganglion may play an important role in the development of basilar artery vasospasm. The beneficial effect of sympathectomy for the prevention of cerebral vasospasm may be explained through this mechanism.
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http://dx.doi.org/10.1016/j.autneu.2011.06.008DOI Listing
December 2011

Subarachnoid, subdural and interdural spaces at the clival region: an anatomical study.

Turk Neurosurg 2011 ;21(3):372-7

M.H. Ataturk Training and Research Hospital, 2nd Department of Neurosurgery, Ankara, Turkey.

Aim: We aimed to show the significance of the anterior pontine membrane as a determining structure between the subdural and subarachnoid space in the clival region.

Material And Methods: Five adult cadaver heads and five cerebral hemispheres were used. The skull vault and hemipheres were removed by sectioning through the pontomesencephalic junction. Five other heads hemispheres were removed but the arachnoid membrane was protected and the cerebral side of the clival dura mater was dissected. In another specimen, the dural porus of the abducens nerve was sectioned for histological evaluation. Three cases of hematoma at the clivus were presented to support our findings.

Results: The anterior pontine membrane is the arachnoid membrane forming the anterior wall of the prepontine cistern with its lateral extension at the skull base. This membrane forms the subdural and subarachnoid spaces by forming a barrier between the clival dura mater and neurovascular structures of the brainstem. There were rigid fibrous trabeculations between both cerebral and periosteal dural layers forming the basilar plexus as the interdural space in the clivus.

Conclusion: The anterior pontine membrane separates the subdural and subarachnoid spaces at the clival region. The hematomas of the clival region require to be evaluated with consideration given to the existance of the subdural space.
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http://dx.doi.org/10.5137/1019-5149.JTN.3913-10.1DOI Listing
December 2011

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

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

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

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

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

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

Conclusions: This study shows that PFD and duraplasty for the treatment of CTD grade 3 Chiari malformation may lead to a more reliable reduction in the volume of concomitant syringomyelia and JOA scores. In CTD grade 1 and 2 patients, PFD without duraplasty may be performed.
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http://dx.doi.org/10.1016/j.wneu.2010.09.005DOI Listing
February 2011

One of the giants of neurological surgery left us more than a decade ago, and neurosurgical literature did not show much interest.

Neurol Neurochir Pol 2011 Jan-Feb;45(1):63-7

Tophane Mahallesi, Laleli Sok, Yilmaz Apt 14/3, 53100 Merkez-Rize, Turkey.

One of the giants of neurological surgery left us over a decade ago. Charles George Drake died September 15, 1998 in London, Ontario after an extended bout with lung cancer. Although he will always be identified with taking posterior fossa aneurysm surgery from the realm of the daring to the domain of the routine, his contributions were much broader. Clinical neurosciences have been blessed in the past century by the life and works of Drake. In the neurosurgical world, the achievements of Drake are very well known and have been well recorded. Unfortunately, in the past decade since his passing, only one paper has been published about him and his contributions to neurosurgery. This is a historical paper regarding Charles George Drake that attempts to (1) remember Drake as a pioneer; (2) to evaluate lessons that we have learned from him; and (3) to address the question 'What made him great?'. As per Drake's teachings, this paper is meant to articulate the unique perspectives Charlie provided with respect to how we learn our craft, maintain the integrity of reporting, and implement suggestions as to how we may progress into the future. In conclusion, it is our hope that this paper will bring to life the unique character of Drake and his unprecedented blend of genius, creativity, technical skill, introspection, and ever-present humility for all international neurosurgeons to appreciate.
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http://dx.doi.org/10.1016/s0028-3843(14)60061-xDOI Listing
September 2011

What makes Maurice Ravel's deadly craniotomy interesting? Concerns of one of the most famous craniotomies in history.

Acta Neurochir (Wien) 2010 Apr 25;152(4):737-42. Epub 2009 Sep 25.

Department of Neurosurgery, Rize Medical School, Rize, Turkey.

Maurice Ravel (1875-1937), the great impressionist-classicist composer of many popular compositions, such as the Boléro, suffered from a progressive disease and died following an exploratory craniotomy by Clovis Vincent. The history of his progressive dementia and the contribution of a car accident, following which he was unable to function, have received a certain amount of interest in the neurological literature previously, but his deadly craniotomy was not evaluated from a neurosurgery perspective. The car accident in 1932, with the probable consequence of a mild-to-moderate traumatic brain injury, could be the key event in his life, triggering the loss of his ability to compose. It is clear that he never recovered from his injury and within a year he became completely unable to function. His dementia progressed dramatically. This event needs to be kept in mind. In 1937, Ravel died after the craniotomy performed by Vincent, but only a speculative, retrospective diagnosis is possible since an autopsy was not undertaken.
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http://dx.doi.org/10.1007/s00701-009-0507-yDOI Listing
April 2010