Publications by authors named "Yavuz Aras"

40 Publications

Transpulmonary thermodilution monitoring-guided hemodynamic management improves cognitive function in patients with aneurysmal subarachnoid hemorrhage: a prospective cohort comparison.

Acta Neurochir (Wien) 2019 07 18;161(7):1317-1324. Epub 2019 May 18.

Department of Anesthesiology and Reanimation, Istanbul University, Istanbul Medical Faculty, Turgut Ozal cad. Fatih, Istanbul, Turkey.

Background: The effects of goal-directed hemodynamic management using transpulmonary thermodilution (TPT) monitor on the cognitive function of patients with aneurysmal subarachnoid hemorrhage (aSAH) remain unclear. The present study aimed to determine whether hemodynamic management with TPT monitor provides better cognitive function compared with standard hemodynamic management.

Methods: Patients with aSAH who were admitted to the intensive care unit in 2016 were assigned to cohort 1, and those admitted in 2017 were assigned to cohort 2. In cohort 1, hemodynamic and fluid management was performed in accordance with the traditional pressure-based hemodynamic parameters and clinical examination, whereas in cohort 2, it was performed in accordance with the TPT monitor-measured flow-based parameters. The incidence of delayed cerebral ischemia (DCI) and pulmonary edema (PE) was determined. The functional outcome of patients was assessed using the modified Rankin scale (mRS) score and Montreal cognitive assessment (MoCA) test at 1 year following aSAH.

Results: Cohort 1 included 45 patients and cohort 2 included 39 patients who completed the trial. The incidence of DCI (38% versus 26%) and PE (11% versus 3%) was comparable between the cohorts (p > 0.05). The mRS score was similar between the cohorts (p = 0.11). However, the MoCA score was 20.2 (19.2-21.4) and 23.5 (22.2-24.8) in cohort 1 and cohort 2, respectively (p < 0.001). Accordingly, the occurrence of poor MoCA score (38% versus 18%) was significantly lower in cohort 2 (p = 0.045).

Conclusions: TPT monitor-based hemodynamic management provides better cognitive outcome than standard hemodynamic management in patients with aSAH.
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http://dx.doi.org/10.1007/s00701-019-03922-4DOI Listing
July 2019

Gray-to-white matter ratio predicts long-term recovery potential of patients with aneurysmal subarachnoid hemorrhage.

Neurosurg Rev 2020 Feb 22;43(1):195-202. Epub 2018 Sep 22.

Istanbul Medical Faculty, Department of Anesthesiology and Reanimation, Istanbul University, Istanbul, Turkey.

Predicting recovery potential of patients with aneurysmal subarachnoid hemorrhage (aSAH) is challenging. We investigated whether the gray-to-white matter ratio (GWR) predicts recovery of cognitive function (CF) and quality of life (QOL) of these patients. We analyzed data of 69 patients with aSAH. Patients' demographics, comorbidities, and neurological status were recorded. One year after aSAH, Montreal Cognitive Assessment (MoCA) and Short Form-36 (SF-36) tests were administered to the patients, and brain volumes of patients were examined using MRI. Three years after aSAH, MoCA and SF-36 tests were conducted again. Differences between the test scores 1 and 3 years after aSAH were evaluated (ΔMoCA and ΔSF-36). Patients with ΔMoCA ≥ 4 points and those with ΔSF-36 ≥ 8 points were referred to as good MoCA and SF-36 recovery, respectively. ΔMoCA correlated with GWR in male and female patients (females: p < 0.001, R = 0.581; males: p < 0.001, R = 0.481). In female patients, GWR > 1.34 predicted good MoCA recovery with 82.3% sensitivity and 80% specificity, and in male patients, GWR > 1.36 predicted good MoCA recovery with 80% sensitivity and 95% specificity. ΔSF-36 correlated with GWR in male and female patients (females: p < 0.001, R = 0.479; males: p < 0.001, R = 0.627). In female patients, GWR > 1.35 predicted good SF-36 recovery with 74% sensitivity and 84% specificity, and in male patients, GWR > 1.38 predicted good SF-36 recovery with 72% sensitivity and 92% specificity. GWR is a good predictor of the recovery of CF and QOL in patients with aSAH and, thus, can help physicians to better organize rehabilitation of patients.
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http://dx.doi.org/10.1007/s10143-018-1029-yDOI Listing
February 2020

Assessment of the MRI and Behavioral Test Results in a Focal Cerebral Ischemia-Reperfusion Model in the Rat after Separate and Combined Use of Mouse-Derived Neural Progenitor Cells, Human-Derived Neural Progenitor Cells and Atorvastatin.

Turk Neurosurg 2018 ;28(4):571-581

Medipol University Hospital, Department of Neurosurgery, Istanbul, Turkey.

Aim: To assess the efficacy of Neural progenitor cell (NPC) transplantation in ischemic stroke, and to investigate whether atorvastatin enhances therapeutic potency of NPC after stroke.

Material And Methods: The focal cerebral ischemia-reperfusion model was performed by transient occlusion of middle cerebral artery. Rats were assigned randomly to receive intracerebral transplantation of mouse NPC alone (mNPC), human NPC alone (hNPC), mouse NPC plus oral atorvastatin (mNPC+A), human NPC plus oral atorvastatin (hNPC+A), oral atorvastatin alone, or intracerebral Dulbecco"s Modified Eagle"s medium injection (control group). Adhesive removal, rotarod, cylinder tests, and magnetic resonance imaging (MRI) were used for assessment of rats during 4 weeks. After sacrification on 28th day, rats were investigated by immunofluorescent staining.

Results: The hNPC and mNPC groups showed significantly improved functional outcome and reduced infarct area ratio compared with the control group. The hNPC group had significantly better performance and lower infarct area ratio than the mNPC group. Addition of atorvastatin to stem cell therapy significantly improved functional outcome, although it did not affect the infarct area ratio on MRI. Anti-inflammatory response in the infarct area was higher in the mNPC group. NPC transplantation significantly reduced the amount of microglia and a significant increase in the amount of astrocytes. CD8a+ T lymphocyte and granzyme B activities were not detected in any of the subjects.

Conclusion: Both hNPC and mNPC treatments significantly improved functional outcome, and reduced infarct area ratio after stroke. Atorvastatin enhanced the therapeutic potency of NPCs, including neurological improvement.
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http://dx.doi.org/10.5137/1019-5149.JTN.21789-17.1DOI Listing
November 2018

Neurosurgical treatment of nonconvulsive status epilepticus due to focal cortical dysplasia.

Epilepsy Behav Case Rep 2018 16;10:4-7. Epub 2018 Apr 16.

Istanbul Faculty of Medicine, Department of Clinical Neurophysiology, Istanbul University, Istanbul, Turkey.

We present a rare case of focal cortical dysplasia (FCD) and nonconvulsive status epilepticus (NCSE) treated successfully with early surgical intervention. Our case is a 9-year-old boy whose seizures, characterized by short episodes of loss of consciousness, appeared at the age of 7, and he showed progressive cognitive decline in the following years. NCSE was diagnosed, and his MRI revealed FCD in the left frontal region which was the same side as his EEG abnormality. Following lesionectomy, his NCSE disappeared and cognitive functions improved. Histopathologic analysis of the resected tissue revealed type-IIB FCD. This case illustrates the importance of early surgery to help restore cognitive functions by eliminating the clinical and electrophysiological features of NCSE.
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http://dx.doi.org/10.1016/j.ebcr.2018.03.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6050350PMC
April 2018

Factors Determining the Outcome in Trigeminal Neuralgia Treated With Percutaneous Balloon Compression.

World Neurosurg 2017 Nov 30;107:69-74. Epub 2017 Jul 30.

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

Objective: To analyze 3T magnetic resonance imaging (MRI) findings and clinical features of patients with trigeminal neuralgia (TN) who underwent percutaneous balloon compression and to determine whether these findings had an impact on prognosis of TN.

Methods: A retrospective review of patients with TN who underwent percutaneous balloon compression in the Neurosurgery Department at Istanbul Faculty of Medicine between January 1, 2007, and January 1, 2016, was undertaken. Of 105 patients who underwent percutaneous balloon compression, 27 patients who received surgical treatment for the first time for typical TN were included in the study. Follow-up data, clinical features, and 3T MRI findings were analyzed retrospectively. MRI findings and clinical features of patients with and without recurrence of TN were compared. The correlation between fractional anisotropy (FA) values and recurrence was investigated.

Results: During follow-up, 9 (33%) patients had recurrence. The patients with recurrence had longer duration of symptoms (P = 0.032), higher FA difference (P = 0.042), and higher FA difference rate (P = 0.023). A trend toward early recurrence was found in patients with higher FA difference rate, although this was not significant (P = 0.051, R = 0.319).

Conclusions: Symptom duration was longer and microstructural changes were more apparent in patients with recurrence. In addition to age, comorbidities, and other clinical and radiographic features, symptom duration and FA values obtained with 3T MRI might be valuable information in surgical decision making.
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http://dx.doi.org/10.1016/j.wneu.2017.07.132DOI Listing
November 2017

Factors Determining the Outcome in Trigeminal Neuralgia Treated With Percutaneous Balloon Compression.

World Neurosurg 2017 Nov 30;107:69-74. Epub 2017 Jul 30.

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

Objective: To analyze 3T magnetic resonance imaging (MRI) findings and clinical features of patients with trigeminal neuralgia (TN) who underwent percutaneous balloon compression and to determine whether these findings had an impact on prognosis of TN.

Methods: A retrospective review of patients with TN who underwent percutaneous balloon compression in the Neurosurgery Department at Istanbul Faculty of Medicine between January 1, 2007, and January 1, 2016, was undertaken. Of 105 patients who underwent percutaneous balloon compression, 27 patients who received surgical treatment for the first time for typical TN were included in the study. Follow-up data, clinical features, and 3T MRI findings were analyzed retrospectively. MRI findings and clinical features of patients with and without recurrence of TN were compared. The correlation between fractional anisotropy (FA) values and recurrence was investigated.

Results: During follow-up, 9 (33%) patients had recurrence. The patients with recurrence had longer duration of symptoms (P = 0.032), higher FA difference (P = 0.042), and higher FA difference rate (P = 0.023). A trend toward early recurrence was found in patients with higher FA difference rate, although this was not significant (P = 0.051, R = 0.319).

Conclusions: Symptom duration was longer and microstructural changes were more apparent in patients with recurrence. In addition to age, comorbidities, and other clinical and radiographic features, symptom duration and FA values obtained with 3T MRI might be valuable information in surgical decision making.
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http://dx.doi.org/10.1016/j.wneu.2017.07.132DOI Listing
November 2017

Effect of Visible Light on Vasospasticity of Post-Subarachnoid Hemorrhage Cerebrospinal Fluid.

J Neurol Surg A Cent Eur Neurosurg 2017 Nov 8;78(6):548-555. Epub 2017 Jun 8.

Department of Neurosurgery, Liv Hospital, Istinye University, İstanbul, Turkey.

 Cerebral vasospasm (CV) is a serious complication of subarachnoid hemorrhage (SAH) with high morbidity and mortality rates. The mechanism of CV has not been determined. There are many theories related to this unsolved issue, one of which supports CV as a two-stage phenomenon from a pathophysiologic perspective. The first stage consists of inhibition of neuronal nitric oxide synthase by oxyhemoglobin, which results in a decrease of nitric oxide (NO) production. The second stage consists of an increase in the levels of asymmetric dimethylarginine through bilirubin oxidation products (BOXes), which are oxidized by-products of hemoglobin metabolism. These in turn inhibit endothelial nitric oxide synthase (eNOS), which results in the blockage of the second NO production mechanism. BOXes are sensitive to visible light, as is their precursor bilirubin. The hypothesis of CV prevention using the photosensitivity of BOXes was tested in this study.  Cerebrospinal fluid (CSF) obtained from two patients with SAH was divided in half and either exposed to a standard dose of visible light or not exposed to any light. The CSF was spectrophotometrically investigated and the concentration of BOXes was measured. A comparison between CSF samples exposed to light and not exposed to light was made. Using two groups of 16 rats each, the vasospastic effect of the CSF exposed and not exposed to light on arteries of the cortical surface was measured. The cortex was exposed using the cranial window.  Spectrophotometric analysis revealed that the concentration of BOXes in the CSF decreased significantly after being exposed to visible light ( < 0.001). There was a significant difference of the vasospastic effect of CSF on exposed cortical arteries ( < 0.001).  The concentration of BOXes and the vasospastic effect of CSF taken from patients with SAH were significantly reduced after being exposed to visible light if compared with CSF not exposed to light.
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http://dx.doi.org/10.1055/s-0036-1594005DOI Listing
November 2017

Fully endoscopic interlaminar and transforaminal lumbar discectomy: Analysis of 47 complications encountered in a series of 835 patients.

Neurocirugia (Astur) 2017 Sep - Oct;28(5):235-241. Epub 2017 May 19.

Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.

Objective: To report perioperative complications in fully endoscopic lumbar discectomy (FELD).

Methods: From September 2010 to November 2016, 835 patients underwent FELD. In total, 865 disc levels were operated on. Of the 835 patients, the transforaminal (TF) approach was used in 174 patients, while 691 patients were operated on using the interlaminar (IL) approach. Surgical complications occurred in 47 patients, which were retrospectively analyzed.

Results: Neurological deficits occurred in six patients. In four of these six patients, deficits resolved spontaneously. In one patient, symptoms resolved after a laminectomy procedure. In only one case, the neurological deficit was permanent. Seven patients complained of dysesthesia, which resolved spontaneously with medical treatment in four patients. In the remaining two patients, dysesthesia symptoms improved after epidural and foraminal injections. Dural tears were encountered in 26 patients. Pudendal neuralgia occurred in three patients. Two cases showed wound infection. The other complications comprised one disc infection, one retroperitoneal hematoma and one wrong level surgery.

Conclusion: The FELD procedure has a steep learning curve and it is a difficult procedure to master. Surgeons should be aware of complications that can occur with the FELD procedure, most of which resolve spontaneously.
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http://dx.doi.org/10.1016/j.neucir.2017.03.003DOI Listing
September 2018

Midterm results of T-stent-assisted coiling of wide-necked and complex intracranial bifurcation aneurysms using low-profile stents.

J Neurosurg 2017 Dec 6;127(6):1288-1296. Epub 2017 Jan 6.

4Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Capa.

OBJECTIVE Coiling of wide-necked and complex bifurcation aneurysms frequently requires implantation of double stents in various configurations. T-stent-assisted coiling involves the nonoverlapping implantation of 2 stents to protect the daughter vessels of bifurcation and is followed by coiling of the aneurysm. The authors studied the feasibility, efficacy, and safety of the T-stent-assisted coiling procedure as well as the midterm angiographic/clinical outcomes of patients with wide-necked bifurcation intracranial aneurysms treated using this technique. METHODS The authors retrospectively identified patients with wide-necked bifurcation intracranial aneurysms treated using double-stent-assisted coiling with a T-stent configuration. RESULTS Twenty-four patients with 24 aneurysms and a mean of age of 51.91 years were identified. The most common locations were the middle cerebral bifurcation (45.8%) and anterior communicating artery (35.7%). T stentings were performed using low-profile stents. The procedures were performed with a technical success rate of 95.8%, and an immediate total occlusion rate of 79.2% was achieved. We observed periprocedural complications in 16.7% of cases and a delayed thromboembolic event in 4.2%. The complications caused permanent morbidity in 1 patient (4.2%). No deaths occurred. The mean angiographic follow-up duration was 9.3 months. The total occlusion rate at the last follow-up was 81.2%. The recanalization rate was 4.5%. Modified Rankin Scale scores of all patients at the last follow-ups were between zero and 2. CONCLUSIONS T-stent-assisted coiling using low-profile stents is a feasible, effective, and relatively safe endovascular technique used to treat wide-necked and complex intracranial aneurysms. The midterm angiographic and clinical outcomes are outstanding.
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http://dx.doi.org/10.3171/2016.9.JNS161909DOI Listing
December 2017

Clinical Course of Non-Traumatic Non-Aneurysmal Subarachnoid Hemorrhage: A Single Institution Experience over 10 Years and Review of the Contemporary Literature.

Turk Neurosurg 2017 ;27(5):732-742

Istanbul University, Istanbul School of Medicine, Department of Neurosurgery, Istanbul, Turkey.

Aim: To report our experience with a relatively large series of patients with non-traumatic non-aneurysmal subarachnoid hemorrhage (NNSAH) to identify the prognosis associated with different bleeding patterns as well as a further diagnostic work-up to determine the underlying cause.

Material And Methods: Between January 2004 and December 2014, 81 patients with angiography-negative non-traumatic subarachnoid hemorrhage (SAH) were treated at our institution. Diagnosis was confirmed with a typical history of spontaneous SAH and cranial computed tomography (CT) scan or lumbar puncture (LP). The patients were grouped according to the bleeding pattern on the CT scan: Group 1: Perimesencephalic (PM) SAH (n=33, 40.7%); Group 2: Non-perimesencephalic (nPM) SAH (n=41, 50.6%); and Group 3: CT-negative NNSAH (n=7, 8.6%). The clinical course, hospitalization period, and complications were noted. All patients underwent an initial four-vessel digital subtraction angiography (DSA). Cranial magnetic resonance imaging (MRI), repeat DSA investigations and spinal MRI were performed in all patients.

Results: The mean hospital stays were 6.3, 14.7 and 10.1 days for patient groups 1, 2, and 3, respectively. The mortality rate was 1.2% (1 patient) in our series. Repeat DSA investigations were positive in two patients (2.5%), both from Group 2 (4.9%). Cranial MRI revealed 100% negative results. Spinal MRI revealed positive results in three patients from Group 2 (7.3%).

Conclusion: We suggest our diagnostic work-up for patients with nPM-SAH, namely repeat DSA and spinal MRI, until an evidence-based guideline is established for the patient management.
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http://dx.doi.org/10.5137/1019-5149.JTN.18359-16.2DOI Listing
March 2018

Antagonist activity of the antipsychotic drug lithium chloride and the antileukemic drug imatinib mesylate during glioblastoma treatment in vitro.

Neurol Res 2016 Sep 1;38(9):766-74. Epub 2016 Jul 1.

e Emine-Bahaeddin Nakıboğlu Faculty of Medicine, Department of Histology and Embryology , Zirve University , Gaziantep , Turkey.

Objectives: Glioblastoma (GBM), the most common primary tumour of the central nervous system, is characterised by a high malignancy and poor prognosis. The aims of this study were to investigate whether the combination of imatinib mesylate (IM) and lithium chloride (LiCl) exhibited a synergistic effect in treatment and to determine whether midkine (MK) affected the fate of this treatment in vitro.

Methods: Monolayer and spheroid cultures of the T98G human GBM cell line were treated with an IM and LiCl combination for 72 h. The cell proliferation index, apoptotic index, cell cycle distribution, apoptotic and anti-apoptotic protein levels, and cAMP level as well as the cellular morphology and ultrastructure were evaluated.

Results: All applications inhibited cell proliferation and induced apoptosis. The most substantial decreases in cell proliferation and the caspase-3, epidermal growth factor receptor (EGFR), platelet derived growth factor receptor-alpha (PDGFR-α), multidrug resistance protein-1 (MRP-1), aquaporin-4 (AQP-4) and cAMP levels were induced by the LiCl treatment, which exhibited more pronounced effects compared with the combination treatment. LiCl was less effective in decreasing the MK and B cell lymphoma-2 (Bcl-2) levels compared with the combination treatment. The most substantial decrease in the p170 levels was identified following the combination treatment, whereas IM induced the second greatest decrease. LiCl alone had no effect on the p170 levels. IM induced the most substantial decrease in the phospho-glycogen synthase kinase 3-beta (p-GSK-3β)/glycogen synthase kinase 3-beta (GSK-3β) ratio, and LiCl induced the second most substantial decrease. Both LiCl and the combination treatment induced G2 + M arrest, whereas IM induced G0 + G1 arrest after 72 h of exposure. An apoptotic appearance and autophagic vacuoles were commonly identified in the LiCl, combination and IM groups, respectively.

Conclusions: The combination of IM and LiCl exhibited an antagonist effect, and MK had a role at this antagonism.
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http://dx.doi.org/10.1080/01616412.2016.1203096DOI Listing
September 2016

Transcortical Removal of Third Ventricular Colloid Cysts: Comparison of Conventional, Guided Microsurgical and Endoscopic Approaches and Review of the Literature.

Turk Neurosurg 2017 ;27(4):546-557

Istanbul University, Istanbul School of Medicine, Department of Neurosurgery, Istanbul, Turkey.

Aim: To compare the clinical results of different transcortical approaches for the removal of third ventricular colloid cysts (CC).

Material And Methods: Records of 41 colloid cyst patients who underwent transcortical conventional microsurgical, microsurgical with the aid of stereotactically guided cylindrical retractor (minitubular), and endoscopic removal between 1999 and 2015 were retrospectively analyzed. The clinical results of these three different transcortical surgical approaches were compared and a literature review of published series was conducted.

Results: Ages ranged between 16 and 66 years (mean: 36.8). There were 18 female and 23 male patients. Headache was the main presenting symptom. The mean CC diameter was 15.5 mm. Intraventricular hemorrhage was encountered in 2 patients. Three patients needed postoperative ventriculoperitoneal shunt surgery. Postoperative seizures were seen in 3, postoperative neurological deficit in 3 and residual tumor in 2 patients. The conventional approach resulted in significantly higher rates of postoperative seizure compared to the minitubular and endoscopic approaches (p=0.012). The rate of residual cyst was significantly higher in endoscopic approach compared to conventional and minitubular approaches (p=0.024). Conventional approach led to significantly higher rates of neurological deficit compared to the two other approaches (p < 0.05).

Conclusion: With respect to complication rates, the stereotactic and endoscopic approaches are both safe and reliable compared to conventional microsurgical approach that has unacceptably high rates of seizures and neurological deficit. Concerning completeness of removal, both microsurgical approaches are by far superior to neuroendoscopy. The stereotactic microsurgical approach compares favorably in both respects with endoscopic and conventional microsurgical approaches.
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http://dx.doi.org/10.5137/1019-5149.JTN.17142-16.2DOI Listing
February 2018

Percutaneous Fully Endoscopic İnterlaminar Approach to the Filum Terminale: A Cadaveric Study.

World Neurosurg 2016 Aug 27;92:402-406. Epub 2016 May 27.

Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.

Objective: To investigate the utility, safety, and feasibility of a novel endoscopic technique for the visualization and surgical manipulation of the filum terminale in fresh postmortem adult human cadavers.

Methods: The filums from 18 fresh postmortem adult human cadavers were explored with a percutaneous fully endoscopic interlaminar approach. After the filum was identified and the nerve roots were dissected away from it, the filum was cut. A specimen was sent for histopathologic examination.

Results: In 15 of 18 (83%) cadavers, the filum terminale could be visualized. A specimen for histopathologic examination was obtained from 11 of 15 (73%) visualized filums. Histopathologic examination revealed that 2 of them were fatty filums, 7 were normal filums, and 2 were peripheral nerves.

Conclusions: We have described a successful and feasible percutaneous fully endoscopic interlaminar approach to the filum terminale. This technique provides a smaller skin incision, narrow durotomy, and minimal tissue damage. Animal studies are necessary to prove the feasibility and safety of our method before clinical use.
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http://dx.doi.org/10.1016/j.wneu.2016.05.055DOI Listing
August 2016

Serum creatine phosphokinase levels as an indicator of muscle injury following lumbar disc surgery: Comparison of fully endoscopic discectomy and microdiscectomy.

Clin Neurol Neurosurg 2016 Jun 9;145:74-8. Epub 2016 Apr 9.

Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.

Objective: The aim of this study is to make a comparison between fully endoscopic lumbar discectomy (FELD) and conventional microdiscectomy (MD) by using pre- and postoperative serum creatine phosphokinase (CPK) levels in correlation with postoperative low-back pain.

Methods: Fortyfive consecutive patients who underwent surgery for lumbar disc herniation were allocated into three groups with 15 patients on each: (1) FELD with interlaminar approach (IL), (2) FELD with transforaminal approach (TF), (3) Conventional MD. Serum CPK levels pre- and 1, 6, 12 and 24h postoperatively, patients' body mass index (BMI), operation duration and hospital stays were recorded. The low-back pain pre- and postoperatively was assessed with the use of the 100mm visual analog scale (VAS) and the "Oswestry Disability Index" (ODI).

Results: There were 16 female (35.5%) and 29 male (64.5%) patients with a mean age of 44.1 years. CPK levels at 6th, 12th and 24th hours postoperatively were found significantly lower in TF and IL groups compared to MD group (p<0.004). Mean operation duration was significantly shorter in MD group (p: 0.014). There was a significant decrease in both the VAS and ODI scores after the surgery in all patient groups (p<0.001). Postoperative VAS scores were found significantly higher in MD group (p: 0.04).

Conclusion: Minimal invasive nature of FELD procedures compared to the MD was substantiated by serum CPK levels in this study. To draw definitive conclusions regarding pain relief, larger patient samples should be evaluated, although postoperative VAS scores were found in favor of FELD.
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http://dx.doi.org/10.1016/j.clineuro.2016.04.004DOI Listing
June 2016

The Effects of Adipose Tissue-Derived Mesenchymal Stem Cell Transplantation During the Acute and Subacute Phases Following Spinal Cord Injury.

Turk Neurosurg 2016 ;26(1):127-39

Istanbul University, Istanbul School of Medicine, Department of Neurosurgery, Istanbul, Turkey.

Aim: To investigate the effectiveness of rat adipose tissue-derived (rAT) mesenchymal stem cell (MSC) transplantation on the functional restoration and regeneration of spinal cord injury (SCI).

Material And Methods: Six of 48 Wistar albino rats were sacrificed to obtain MSCs, and the remaining rats were divided randomly into six groups. SCI was performed using the clip compression method. The control and transplantation groups were injected with physiological saline and a rAT-MSC suspension at the injury sites, respectively. Each animal was evaluated using the Basso, Beattie and Bresnahan (BBB) rating system and sacrificed at 28 days post-injury period (p.i.). The regeneration process was evaluated based on immunostaining against β3-tubulin, BDNF, CNTF, and CNPase.

Results: rAT-MSC transplantation into the SCI site substantially improved the tissue regeneration and functional recovery (p < 0.05). However, the rAT-MSC transplantation at 9 days p.i. was not more efficient on functional recovery than the transplantation immediately after injury. The expression of β3-tubulin, BDNF and CNTF at the injury site indicated the potential for functional regeneration.

Conclusion: The adaptive nature of rat-MSCs enabled the remodulation and regeneration of the lesion site, decreasing the importance of transplantation time in the treatment of SCI.
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http://dx.doi.org/10.5137/1019-5149.JTN.15724-15.0DOI Listing
September 2016

Surgery for Pyogenic Brain Abscess over 30 Years: Evaluation of the Roles of Aspiration and Craniotomy.

Turk Neurosurg 2016 ;26(1):39-47

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

Aim: To evaluate the roles of craniotomy and aspiration in the treatment of pyogenic brain abscess throughout 30 years of computerized tomography.

Material And Methods: A retrospective study of 224 patients who were surgically treated at Istanbul Medical Faculty, Department of Neurosurgery between 1982 and 2012 was undertaken. The records were analyzed for demographic, clinical and radiological findings, surgical interventions (resection, free-hand aspiration and image-guided aspiration), data regarding abscesses (etiological factors, site, size, number, localization and identified microorganism), corticosteroid and antibiotic usage and complications, and the outcomes were reviewed.

Results: The male-to-female ratio was 2.2, and the mean age was 26.2±1.25 years. The most common presenting symptom was headache (56.7%), followed by nausea and vomiting (28.5%). Otitis media and mastoiditis were the most common causes of abscess (41.9%), and 44 patients had multiple abscesses. Aerobic gram-positive microorganisms were the most frequently isolated pathogens in culture (51.5%). Primary surgical interventions were as follows: craniotomy and resection (38.8%), free-hand aspiration (49.1%) and image-guided aspiration (12.1%). The aspiration-to-resection ratio was 1.36 (64/47) in the first decade, 2.94 (50/17) in the second decade and 1 (23/23) in the last decade. Age, level of consciousness at the time of admission and potent corticosteroid usage were found to be significantly associated with mortality (p=0.001, p≤0.001 and p=0,038, respectively). The total morbidity and mortality ratios were 4.9% and 9.8%, respectively. Seizures were more common in patients of craniotomy group (p=0.023).

Conclusion: Treatment of pyogenic brain abscess remains challenging, despite advances in surgical and imaging technology, and craniotomy retains a significant role in surgical treatment.
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http://dx.doi.org/10.5137/1019-5149.JTN.15099-15.1DOI Listing
August 2016

Fully endoscopic supraorbital keyhole approach to the anterior cranial base: A cadaveric study.

J Neurosci Rural Pract 2015 Jul-Sep;6(3):361-8

Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.

Introduction: The supraorbital keyhole approach for anterior cranial base lesions has been increasingly used in clinical practice. Anatomical studies focusing on the endoscopic anatomy via this approach are few, although the microscopic anatomy has been well studied. The aim of this study is to describe the anatomical features and surgical exposure provided by the endoscopic supraorbital keyhole approach using quantitative measurements.

Materials And Methods: Nine formalin-fixed human cadavers from the inventory of the Anatomy department were used. A total of 18 supraorbital keyhole cranitomies were conducted. The distances between the target anatomical structures and the dura mater at the craniotomy site, and the distances between deep anatomical structures were measured with purpose-designed hooks.

Results: The distance between the dura mater and optic canal was measured as 69.5 ± 6.7 mm (62-83 mm); optic chiasm as 76.2 ± 5.4 mm (67-86 mm); anterior communicating artery as 82.6 ± 6.1 mm (71-93 mm); internal carotid artery (ICA) bifurcation as 74.7 ± 6.0 mm (66-84 mm) and the basilar tip as 94.9 ± 7.0 mm (87-111 mm). The mean diameter of the optic canal was 7.4 ± 1.3 mm (6-11 mm), whereas the mean diameter of diaphragma sellae was measured as 8.4 ± 1.1 mm (7-10 mm).

Conclusions: The results of this study showed that the anterior and medial aspects of the anterior cranial fossa can be visualized properly. Dissection of the ipsilateral arteries of Circle of Willis can be performed easily using an endoscopic supraorbital keyhole approach.
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http://dx.doi.org/10.4103/0976-3147.154568DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4481791PMC
July 2015

Memantine and Q-VD-OPh Treatments in Experimental Spinal Cord Injury: Combined Inhibition of Necrosis and Apoptosis.

Turk Neurosurg 2016 ;26(5):783-9

Istanbul University, Istanbul School of Medicine, Department of Neurosurgery, Istanbul, Turkey.

Aim: To evaluate the effects of NMDA receptor antagonist memantine and pancaspase inhibitor Q-VD-Oph in combination or alone in experimental spinal cord injury.

Material And Methods: 45 male Sprague-Dawley rats were divided into five groups. Spinal cord injury was created with the clip compression technique. The drugs were administered either alone of in combination to the subjects according to their groups. Motor function was assessed with Tarlov's motor grading scale and the inclined plane technique. The subjects were sacrificed at the fifth postoperative day. Histopathological examination was done with the use of hematoxylin eosin and TUNEL staining.

Results: The results for TUNEL staining and apoptotic cell counts revealed statistically significant differences in Q-VD-Oph and combined treatment groups. Tarlov motor grading scale and inclined plane test results were also found significantly better in these two groups.

Conclusion: Combined use of memantine and Q-VD-OPh provides better histological and clinical results. The combined inhibition of the two major pathways, necrosis and apoptosis, needs to be further assessed with in-vivo or in-vitro studies.
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http://dx.doi.org/10.5137/1019-5149.JTN.12999-14.1DOI Listing
March 2017

Use of Antifibrotics to Prevent Ventriculoperitoneal Shunt Complications Due to Intra-abdominal Fibrosis: Experimental Study in a Rat Model.

J Neurol Surg A Cent Eur Neurosurg 2015 May 26;76(3):219-23. Epub 2015 Mar 26.

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

Background: Cerebrospinal fluid shunt operations have reduced the morbidity and mortality of hydrocephalus, but have potential complications. Ventriculoperitoneal (vp) shunt obstruction is one of the common complications of shunt surgery. The obstruction is caused by fibrosis and is usually located on the tip of the ventricular and/or peritoneal catheter.

Objective: In our study, we aimed to demonstrate the known antifibrotic effects of heparin, hyaluronate/carboxymethylcellulose, and icodextrin on peritoneal catheter obstruction in a vp shunt model in rats.

Methods: Thirty-two male Sprague-Dawley rats were used in this study. A shunt catheter was placed in the abdominal cavity. In the control group, isotonic solution, in the study groups, heparin, sodium hyaluronate/carboxymethylcellulose (HA/CMC), and icodextrin were intraperitoneally applied. The severity of adhesions and inflammation around the peritoneal catheter was evaluated after the rats were killed on day 30.

Results: One animal in the heparin group died due to intra-abdominal hemorrhage. We found the most adhesions in the control group. All three drugs (heparin, HA/CMC, icodextrin) were effective for adhesion prevention. HA/CMC was more effective than heparin, and icodextrin was most effective. There was a statistically significant difference between the icodextrin and the control group (p = 0.007).

Conclusion: The intra-abdominal instillation of icodextrin, HA/CMC, and heparin, especially icodextrin, can decrease the rate of vp shunt dysfunction by preventing formation of intraperitoneal fibrosis.
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http://dx.doi.org/10.1055/s-0034-1389369DOI Listing
May 2015

A malignant transformation of a spinal epidural mass from ganglioneuroblastoma to neuroblastoma.

J Korean Neurosurg Soc 2015 Mar 20;57(3):211-4. Epub 2015 Mar 20.

Department of Neurosurgery, School of Medicine, Istanbul University, Istanbul, Turkey.

Ganglioneuromas are benign tumors. Surgical excision is the treatment of choice with very good prognosis. However, neuroblastomatous malignant transformation of ganglioneuromas was previously reported. We report a patient with spinal neuroblastoma recurrent from a ganglioneuroblastoma after disease free survival of 13 years. This is one of the rare examples of spinal neuroblastoma and to our knowledge the second case report with malignant transformation from a ganglioneuroblastoma or a ganglioneuroma. The present case is the only report in the literature with further genetic investigations.
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http://dx.doi.org/10.3340/jkns.2015.57.3.211DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4373052PMC
March 2015

Neuronavigation-assisted percutaneous balloon compression for the treatment of trigeminal neuralgia: The technique and short-term clinical results.

Br J Neurosurg 2015 25;29(4):552-8. Epub 2015 Mar 25.

a Department of Neurosurgery , Istanbul School of Medicine, Istanbul University , Istanbul , Turkey.

Background: Percutaneous balloon compression (PBC) has been widely used in the treatment of trigeminal neuralgia. However, this technique has a steep learning curve and significant complications were reported that were related to foramen ovale puncturing. The aim of this study was to evaluate the clinical results of a small patient group who underwent neuronavigation-assisted PBC.

Methods: An intraoperative computed tomography (CT) device (CereTom, Neurologica, Danvers, MA/USA) was used to obtain CT scans with 2-mm slice thicknesses. The data were transferred to a neuronavigation system planning station (BrainLab, Feldkirchen, Germany). A soft touch registration system was used for image registration. With the image guidance, a trajectory was defined and the foramen ovale was cannulated using neuronavigation and Hartel's landmarks.

Results: Sixteen procedures were performed on 13 patients (4 female and 9 male) without complications. The total length of the procedure was not more than 57 min in all instances.

Conclusions: We believe that image-guided neuronavigation is useful for neurosurgeons who are at the beginning of their PBC learning curve. It may also be an alternative for particular patients with significant anatomic variations that result in an unsuccessful foramen ovale puncture.
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http://dx.doi.org/10.3109/02688697.2015.1019418DOI Listing
June 2016

Fully endoscopic interlaminar and transforaminal lumbar discectomy: short-term clinical results of 163 surgically treated patients.

World Neurosurg 2014 Nov 4;82(5):884-90. Epub 2014 Jun 4.

Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.

Objective: To evaluate the clinical outcomes of patients with lumbar disc disease undergoing fully endoscopic surgery at a single clinic.

Methods: Between August 2009 and January 2012, 163 patients (74 men and 89 women) underwent fully endoscopic lumbar discectomy. All patients were followed for 1 year after surgery. The Oswestry Disability Index and a visual analog scale were used to analyze outcomes.

Results: During the follow-up period, 114 (70%) patients had no complaints, 30 (18%) patients had occasional pain, and 19 (12%) patients had no improvement. During postoperative follow-up, 8 patients required repeat surgery for recurrence or residual fragments. Postoperatively, 4 patients experienced dysesthesia, which completely resolved in time. Neurologic deterioration occurred in 5 patients, 4 of whom recovered completely without any intervention. Dural tears occurred in 6 patients.

Conclusions: Fully endoscopic interlaminar or transforaminal surgeries are safe and effective treatment modalities for lumbar disc herniations. Despite the difficulties of acquiring this new technique, good results can be achieved with sufficient experience.
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http://dx.doi.org/10.1016/j.wneu.2014.05.032DOI Listing
November 2014

Unilateral endoscopic optic nerve decompression for idiopathic intracranial hypertension: a series of 10 patients.

World Neurosurg 2014 Nov 2;82(5):745-50. Epub 2014 Apr 2.

Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.

Objective: Several surgical treatment modalities, including lumboperitoneal or ventriculoperitoneal shunt surgery, subtemporal decompression, endovascular venous sinus stenting, optic nerve decompression (OND), were used in the management of idiopathic intracranial hypertension (IIH). Each surgical technique has different advantages and disadvantages. Endoscopic OND is rarely used in the management of IIH. There are only four reported cases. The aim of this study is to describe the surgical results of patients treated with this less invasive surgical technique.

Methods: A series of 10 consecutive cases of unilateral OND was reviewed. Between December 2008 and December 2012 these patients underwent the endoscopic approach without nerve sheath opening. Presenting symptoms, neurological examination findings, magnetic resonance venography imaging results, fundoscopic and visual acuity examination findings, and automated perimetry test results were recorded. Perioperative results, including complications and length of hospital stay, were evaluated. Findings at follow-up evaluations were also recorded.

Results: This report is the first series of unilateral OND performed using the endoscopic approach. The mean patient age was 34.1 years (range, 9-49 years); there were nine female and one male patients. Visual impairment was the main symptom in this patient group, whereas headache was a secondary complaint. The patients were first managed with medical treatment for at least 3 months. Unilateral endoscopic OND was performed on the side with the most visual failure. Mean follow-up was 28.4 months (range, 8-55 months). The visual field defects and visual acuity improved in eight of nine patients, whereas papilloedema improved in seven of nine patients. Also headaches resolved in four of seven patients. There were no complications in this relatively small series.

Conclusions: The surgical treatment of IIH by using the unilateral endoscopic OND technique is a safe and effective method in the hands of experienced surgeons with advanced endoscopic skills. A collaboration with the ophthalmology team is needed for the follow-up. Further studies with larger patient numbers is needed to compare unilateral endoscopic OND technique with the current techniques used in the surgical management of IIH.
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http://dx.doi.org/10.1016/j.wneu.2014.03.045DOI Listing
November 2014

Sorafenib and lithium chloride combination treatment shows promising synergistic effects in human glioblastoma multiforme cells in vitro but midkine is not implicated.

Neurol Res 2014 Mar;36(3):189-97

Objectives: The objectives of this study were to test the effects of the new combination treatment modality, sorafenib (SOR) and lithium chloride (LiCl) and to assess whether midkine (MK) protein has a role in any potential effects.

Methods: Monolayer and spheroid cultures of T98G human glioblastoma multiforme (GBM) cells were treated with LiCl and SOR (inhibition concentration 50 value  =  100 μM), or their combination, or were left untreated (control). Cell proliferation and apoptotic indices, the mechanism of action, and the levels of apoptotic and anti-apoptotic proteins were evaluated in monolayer cultures and ultrastructure was evaluated by transmission electron microscopy (TEM) in spheroid cultures after for 72 hours.

Results: All drug applications decreased cell numbers and increased the apoptotic index. The combination shows a synergistic effect. In the combination group, the decrease in cell numbers and the increase in the apoptotic index were significantly greater than with the individual drugs (P < 0.01). The combination treatment led to the greatest decreases in MRP-1 and p170 levels; but the greatest decreases in p-STAT-3, p-ERK (P < 0.05), p-AKT, p-GSK-3-beta (P < 0.01), EGFR (P < 0.01), NF-kappa-β levels were with SOR alone, followed by the combination. The decreases in MK levels in the SOR and combination groups were similar (P  =  0.06). Severe ultrastructural damage was more frequently observed in the combination group compared with the other groups.

Conclusions: These results suggest the possibility that the addition of LiCl to SOR could improve the prognosis in at least some patients who need both cancer and psychotherapy and indicate the need for further studies.
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http://dx.doi.org/10.1179/1743132813Y.0000000283DOI Listing
March 2014

Functional outcomes after treatment of traumatic brachial plexus injuries: clinical study.

Ulus Travma Acil Cerrahi Derg 2013 Nov;19(6):521-8

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

Background: The aim of this study is to evaluate functional outcome and quality of life using statistically validated tools.

Methods: Participating patients were called and asked questions from the Short Form 36 (SF-36), the Disability of the Arm, Shoulder and Hand (DASH) questionnaire, a pain scale and an additional question on their satisfaction with surgery.

Results: A total of 33 patients were operated by a single surgeon (MI) between 1997 and 2010 at the Neurosurgery Department of Istanbul School of Medicine. Three of these patients refused to participate and three other patients were excluded, leaving 27 patients, with an average follow-up of 79,6 months, for review. The most common cause of traumatic brachial plexus injuries (TBPI) was motor vehicle accidents. Fourteen patients had isolated supraclavicular injuries and three patients had infraclavicular injuries. The remaining 10 patients' injuries were both supra- and infraclavicular. Avulsion was encountered in three patients. The patients who were operated within the first six months after trauma represented significantly better scores in DASH, SF-36 and pain scale.

Conclusion: Statistically validated tests like DASH and SF-36 questionnaires are valuable tools for evaluating TBPI patients. Centers specialized in treating TBPI with surgery may use these tests pre- and postoperatively which lead to objective personalized evaluation of patients' subjective symptoms.
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http://dx.doi.org/10.5505/tjtes.2013.48107DOI Listing
November 2013

Emergency management of an acute tension pneumocephalus following ventriculoperitoneal shunt surgery for normal pressure hydrocephalus.

Turk Neurosurg 2013 ;23(4):564-7

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

Tension pneumocephalus is a rare and life threatening complication of intracranial surgical procedures, and requires immediate recognition and surgical intervention. Tension pneumocephalus following ventriculoperitoneal shunt surgery is extremely rare and commonly seen as a delayed complication. To our knowledge, early postoperative tension pneumocephalus after shunt surgery was reported only in one other publication. We present a case of acute tension pneumocephalus following ventriculoperitoneal shunt surgery for normal pressure hydrocephalus, which was managed well with close neurological follow-up and rapid surgical intervention. The use of the portable CT scanner in this case saved significant time, without the transport of the patient to the radiology unit, made early surgical intervention possible, and prevented morbidity and mortality.
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http://dx.doi.org/10.5137/1019-5149.JTN.5822-12.0DOI Listing
May 2014

Primary multiple cerebral hydatid disease: still symptomatic despite pathologically confirmed death of the cyst.

Turk Neurosurg 2013 ;23(4):505-8

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

Hydatid disease is a life-threatening parasitic infestation caused by Echinococcus granulosus. Infection with E. granulosus typically results in the formation of hydatid cysts in liver, lungs, kidney and spleen. Majority of the intracranial cysts are secondary and solitary. Multiple primary cerebral cysts are uncommon. Surgical and medical management of a 14-year-old boy with multiple primary hydatid cysts are presented. 14 cysts, which were symptomatic due to their mass effect, were surgically removed, whereas a deep-seated asymptomatic cyst was followed-up with medical treatment. Despite proper antibiotic regimen the patient was admitted with epileptic seizures six months later. The deep-seated lesion was also surgically removed. Intraoperative observations and pathological examination demonstrated different characteristics, with pericystic gliosis, gel-like cyst content and death scolices within the cavity. In addition to the fact, that the presented case is an additional example for the rare primary multiple cerebral hydatid cysts, to our knowledge it is the first case of a dead cerebral hydatid cyst, causing symptoms despite effective medical treatment.
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http://dx.doi.org/10.5137/1019-5149.JTN.5826-12.1DOI Listing
May 2014

Ascending transaqueductal cystoventriculoperitoneal shunting in Dandy-Walker malformation: technical note.

Pediatr Neurosurg 2012 13;48(6):389-93. Epub 2013 Aug 13.

Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.

The optimal treatment for Dandy-Walker malformation is still controversial. Ventriculoperitoneal shunting, cystoperitoneal shunting or combinations are the most common surgical options in the management of this clinical entity. Endoscopic procedures like ventriculocystostomy, 3rd ventriculostomy or endoscopy-assisted shunt surgeries have become the focus of recent publications. We describe a new transcystic endoscopic technique, with the usage of a single ascending transaqueductal shunt catheter with additional holes, whereby both the posterior fossa cyst and supratentorial ventricular compartments are drained effectively. By using this new technique complications associated with combined shunting can be avoided. In addition, by equalizing the pressure within the supra- and infratentorial compartments, the upward or downward herniations associated with single-catheter shunting can be prevented.
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http://dx.doi.org/10.1159/000353610DOI Listing
May 2014

Effects of combined and individual use of N-methyl-D aspartate receptor antagonist magnesium sulphate and caspase-9 inhibitor z-LEDH-fmk in experimental spinal cord injury.

Ulus Travma Acil Cerrahi Derg 2013 Jul;19(4):313-9

Department of Neurosurgery, İU İstanbul Faculty of Medicine, İstanbul, Turkey.

Background: We investigated the individual and combined effects of magnesium sulphate, which is an N-Methyl-D aspartate receptor antagonist (NMDA), and z-LEHD-FMK, which is a caspase 9 inhibitor, on the genesis of secondary injury in a rat spinal cord injury model. We aimed to minimize the effects of secondary injury in spinal cord trauma by choosing these two agents which served to block the two major mechanisms of cell loss, apoptosis and necrosis.

Methods: The drugs were given to the subjects according to their groups, either in singular or combined fashion. For motor examination, the subjects were kept under close clinical evaluation for five days. Histopathological examination and the emerging spinal cord samples were prepared with haematoxylene-eosin and Tunel techniques.

Results: A statistically significant difference in favor of the treatment groups has been found between the treatment and control groups in terms of histological data. However, there was no difference in the evaluation of motor examination between trauma and treatment groups.

Conclusion: We have found no difference between the individual and combined uses of MgSO4 and z-LEHD-FMK in the prevention of secondary injury; however, there were better histological results in the treatment groups compared to trauma and control groups which gives us hope for future investigations.
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http://dx.doi.org/10.5505/tjtes.2013.45804DOI Listing
July 2013

Whole mitochondrial DNA variations in hippocampal surgical specimens and blood samples with high-throughput sequencing: a case of mesial temporal lobe epilepsy with hippocampal sclerosis.

Gene 2013 Oct 18;529(1):190-4. Epub 2013 Jul 18.

Department of Genetics, Institute for Experimental Medicine, Istanbul University, Istanbul, Turkey.

Introduction: Hippocampal sclerosis is the most common lesion in patients with mesial temporal lobe epilepsy. Recently, there has been growing evidence on the involvement of mitochondria also in sporadic forms of epilepsy. In addition, it has been increasingly argued that mitochondrial dysfunction has an important role in epileptogenesis and seizure generation in temporal lobe epilepsy. Although mtDNA polymorphisms have been identified as potential risk factors for neurological diseases, the link between homoplasmy and heteroplasmy within tissues is not clear. We investigated whether mitochondrial DNA (mtDNA) polymorphisms are involved in a case report of a patient with mesial temporal lobe epilepsy-hippocampal sclerosis (MTLE-HS).

Design: We report the whole genome mtDNA deep sequencing results and clinical features of a 36-year-old woman with MTLE-HS. We used pyrosequencing technology to sequence a whole mitochondrial genome isolated from six different regions of her brain and blood. To assess the possible role of mitochondrial DNA variations in affected tissues, we compared all specimens from different regions of the hippocampus and blood.

Results: In total, 35 homoplasmic and 18 heteroplasmic variations have been detected in 6 different regions of the hippocampus and in blood samples. While the samples did not display any difference in homoplasmic variations, it has been shown that hippocampus regions contain more heteroplasmic variations than blood. The number of heteroplasmic variations was highest in the CA2 region of the brain and accumulated in ND2, ND4 and ND5 genes. Also, dentate and subiculum regions of the hippocampus had similar heteroplasmic variation profiles.

Discussion: We present a new rare example of parallel mutation at 16223 position. Our case suggests that defects in mitochondrial function might be underlying the pathogenesis of seizures in temporal lobe epilepsy.
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http://dx.doi.org/10.1016/j.gene.2013.06.077DOI Listing
October 2013