Erdinc Civelek - Academia.edu (original) (raw)
Papers by Erdinc Civelek
Neurology India, 2010
Epidural steroid injection (ESIs) is one of the treatment modalities for chronic low back pain (C... more Epidural steroid injection (ESIs) is one of the treatment modalities for chronic low back pain (CLBP) with various degrees of success. We analyzed the efficacy of fluoroscopically guided transforaminal epidural steroid injections (TFESIs) via a preganglionic approach in patients with foraminal stenosis due to lumbar spinal stenosis and lumbar discogenic pain with radiculopathy. We analyzed the data of 40 patients (February 2008 and April 2009) with the diagnosis of CLBP and treated by fluoroscopically guided TFESIs via a preganglionic approach. Patients were followed-up at one month (short term), six months (midterm) and one year (long term) after injections. Follow-up data collection included the Visual Numeric Pain Scale (VNS) and North American Spine Society (NASS) patient satisfaction scores. The mean age of the patients was 59.87 +/- 15.06 years (range 30 - 89 years, 25 women). Average follow-up period was 9.22 +/- 3.56 months. Statistically significant differences were observed between the pre-procedure and post-procedure VNSs (P < 0.01, Pearson Correlation Test). Improvements in VNS scores were correlated with improvements in the NASS scores. When the VNS scores were evaluated with respect to the age of patient, level numbers, gender, pre-procedure symptom duration and pre-procedure VNS, no significant differences were found (P < 0.05, linear regression test). At short term evaluation in post treatment (one month), 77.78 % of patients were found to have a successful outcome and 22.22 % were deemed failures. Overall patient satisfaction was 67.23 % in the midterm period. Additionally, 54.83 % of patients (N/n: 15/8) had a successful long-term outcome at a follow-up of one year. Our data suggest that fluoroscopically guided TFESIs via a preganglionic approach, in patients with foraminal stenosis due to lumbar spinal stenosis and lumbar discogenic pain with radiculopathy, has effective outcome and patients responding to injection have significantly lower post-injection pain scores.
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES, 2008
Injuries to the spinal accessory nerve are rare and mostly iatrogenic. Pain, impaired ability to ... more Injuries to the spinal accessory nerve are rare and mostly iatrogenic. Pain, impaired ability to raise the ipsilateral shoulder, and scapular winging on abduction of the arm are the most frequently noted clinical manifestations. As a seldom case, a 20 year-old male with spinal accessory nerve palsy after penetrating trauma by gunshot was reported. Three months after the injury, he was complaining about left arm pain in abduction to shoulder level and a decreased range of movement. On physical examination, wasting of the left trapezium with loss of nuchal ridge and drooping of the shoulder were found. On neurological examination of the left trapezius and sternomastoid muscles, motor function were 3/5 and wide dysesthesia on the neck, shoulder and arm was present. The bullet entered just above the clavicle and exited from trapezium. Radiological studies were normal, where electromyography (EMG) showed neuropathic changes. Surgical exploration showed the intact nerve lying on its natur...
Brucellosis is an infectious disease spread by consumption of non-pasteurized milk products or th... more Brucellosis is an infectious disease spread by consumption of non-pasteurized milk products or through contact with infected animals. Spinal involvement is one of the most important complications and the lumbar area is the most frequently affected site. Among the neurological consequences, nerve root compression can be a result of epidural abscess, granuloma or discitis secondary to vertebral body involvement. In this case report we present a 50-year-old male patient with brucellar discitis without spondylitis which caused lumbar disc herniation. We want to emphasize that discitis should also be considered in differential diagnosis of nerve root compression in suspected cases.
Turkish Neurosurgery, 2010
Cancers that metastasize to the cauda equina are uncommon. Only seventeen cases were reported. Th... more Cancers that metastasize to the cauda equina are uncommon. Only seventeen cases were reported. Those from pulmonary squamous cell carcinoma was never been published to our knowledge. mAterIAl and methOds: A 79-year-old male patient presented with low back pain since 1 year and severe sacral pain irradiating to the left leg, paraparesis, urinary dysfunction and leg weakness since one week. results: Preoperative magnetic resonance images of the lumbar spine showed an intradural spinal mass in L2-3 with infiltration of the cauda equina; the lesion measured 13 mm craniocaudally and 11 mm anteroposteriorly, and thus occupied the majority of the intrathecal space at that level. The magnetic resonance images, surgical treatment, and related pathophysiology are reviewed.
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES
Traumatic acute subdural hematoma is the most lethal of all head injuries. In this study, 113 pat... more Traumatic acute subdural hematoma is the most lethal of all head injuries. In this study, 113 patients with the diagnosis of posttraumatic acute subdural hematoma, who were operated between 1998 and 2006, were reviewed retrospectively. Statistical analysis was performed to detect any effects of the variables of age, Glasgow Coma Scale (GCS) score on admission, time interval between the trauma and operation, and abnormality in the pupil reaction on the disease mortality and morbidity. Results obtained in the study are discussed and compared with the related current literature. The overall mortality in 113 patients was 56.6%. According to the results, the most important determinants of the prognosis are GCS score of the patient on admission, abnormality in pupil reaction, timing of the operation, and the patient's age.
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](Aǧrı : Ağrı (Algoloji) Derneği'nin Yayın organıdır = The journal of the Turkish Society of Algology, 2005
Trigeminal neuralgia is a painful condition of the face characterized by paroxysmal lancinating, ... more Trigeminal neuralgia is a painful condition of the face characterized by paroxysmal lancinating, shock-like pain confined to the somatosensory distribution of the trigeminal nerve. The etiology of most cases of trigeminal neuralgia has been suggested to be vascular compression of the central axons of the trigeminal nerve at the level of pontocerebellar region, so called hyperactive dysfunctional syndrome. Trigeminal neuralgia is the one of the most known pain syndromes. Several neurosurgical procedures have been developed for the treatment of idiopathic trigeminal neuralgia and in this review, idiopathic trigeminal neuralgia was discussed in aspect of different surgical modalities.
No shinkei geka. Neurological surgery, 1982
About a month prior to admission to our hospital, a 25-year-old man had a quarrel with his friend... more About a month prior to admission to our hospital, a 25-year-old man had a quarrel with his friend and was stabbed in his left eye with a cracked bottle of beer. He underwent emergency operation for the injured left eye. Subsequently he was admitted to an ophthalmological ward in our hospital for plastic surgery of an artificial eye. An intracranial foreign body was pointed out, and he was soon transferred to our neurosurgical ward. Plain x-ray films and tomograms of the skull and CT scan showed a foreign body at medial portion of the left superior orbital fissure. Carotid angiography revealed no significant implication of the cerebral vessels. As there was a strong suspicion of cerebral contusion or liquorrhea, a pterional craniotomy was so designed as to do removal of thie foreign body and repair of the dura mater in one stage. The post-operative couse was uneventful without liquorrhea or miningitis. It was emphasized that pterional approach used by Hamby (1970) for surgery of mali...
Early Brain Injury or Cerebral Vasospasm, 2011
the aim of this study was to assess and to compare the ability of intrathecal flunarizine and nim... more the aim of this study was to assess and to compare the ability of intrathecal flunarizine and nimodipine to prevent vasospasm in a rabbit model of subarachnoid hemorrhage (SAH). forty male New Zealand white rabbits were allocated into 5 groups randomly. The treatment groups were as follows: (1) control (no SAH [n = 8]), (2) SAH only (n = 8), (3) SAH plus vehicle (n = 8), (4) SAH plus nimodipine (n = 8), and (5) SAH plus flunarizine (n = 8). Before sacrifice, all animals underwent femoral artery catheterization procedure by open surgery under anesthesia and angiography performed for each animal. there was a statistically significant difference between the mean basilar artery cross-sectional areas and the mean arterial wall thickness measurements of the control and SAH-only groups (p < 0.05). Basilar artery vessel diameter and luminal section areas in group 4 were significantly higher than in group 2 (p < 0.05). Basilar artery vessel diameter and basilar artery luminal section areas in group 5 were significantly higher than in group 2 (p < 0.05).Basilar artery vessel diameter and basilar artery luminal section areas in group 5 were significantly higher than in group 4 (p < 0.05). these findings demonstrate that flunarizine has marked vasodilatatory effect in an experimental model of SAH in rabbits.
Early Brain Injury or Cerebral Vasospasm, 2011
the aim of this study was to assess and to compare the ability of intrathecal nicergoline and nim... more the aim of this study was to assess and to compare the ability of intrathecal nicergoline and nimodipine in prevention of cerebral vasospasm in a rabbit model of subarachnoid hemorrhage (SAH). twenty male New Zealand white rabbits were allocated into four groups randomly. Subarachnoid hemorrhage was induced by injecting autologous blood into the cisterna magna. The treatment groups were as follows: (1) control [no SAH (n = 5)], (2) SAH only (n = 5), (3) SAH plus nimodipine (n = 5), and (4) SAH plus nicergoline (n = 5). there was a statistically significant difference between the mean basilar artery cross-sectional areas and the mean arterial wall thickness measurements of the control and SAH-only groups (p < 0.05). Basilar artery vessel diameter and luminal section areas in group 3 were significantly higher than in group 2 (p < 0.05). Basilar artery vessel diameter and basilar artery luminal section areas in group 4 were significantly higher than in group 2 (p < 0.05). There was no significant difference between basilar artery vessel diameter and basilar artery luminal section areas in group 3 and group 4. these findings demonstrate that intrathecal nicergoline has a vasodilatatory effect in an experimental model of SAH in rabbits but not more than that of nimodipine.
Turkish Neurosurgery, 2014
AIm: This study was aimed to investigate the variations in the spinal nerve root compositions of ... more AIm: This study was aimed to investigate the variations in the spinal nerve root compositions of musculocutaneous nerve and to confirm which spinal nerve root is the main ingredient in participating amount. mATERIAl and mEThods: A total of 20 fresh cadavers were dissected. Brachial plexus and its branches were extracted. Musculocutaneous nerve stump was traced back to the roots to identify its fascicular origin. The number of fascicles originating from a particular nerve root and their axial location with in the nerve were noted.
World Neurosurgery, 2011
To determine the suitability of the application of dynamic stabilization (DS) as a nonfusion tech... more To determine the suitability of the application of dynamic stabilization (DS) as a nonfusion technique to address dysfunctional segmental motion (DSM) in the lumbar spine. Over a 1-year period, 25 patients were treated with the same assessment and surgical protocol. Inclusion criteria were clinical presentation of DSM with or without stenosis. On preoperative and postoperative plain anteroposterior, lateral, and lateral flexion-extension radiographs, anterior and posterior disc height (DH); anteroposterior diameter of the disc; and global, segmental, apical segment, and below level lordotic angles (LAs) were measured. The study included 9 women and 16 men with a mean age of 43.48 years ± 7.6. On average, patients had symptoms for 38.04 months ± 29.6, and mean follow-up was 12.36 months ± 3.46. The average height of anterior, posterior, and mean intervertebral discs increased significantly (P = 0.002, P = 0.003, and P < 0.0001). There were no significant differences between the preoperative and postoperative global, segmental, apical segment, and below segment LAs in flexion, extension, and neutral positions. At mid-term follow-up, no patients showed new signs of degeneration at the adjacent motion segment. Overall, the limited radiologic data advocate DS as a nonfusion technique in the treatment of DSM in the lumbar spine. Long-term follow-up is essential, however, to investigate the long-term efficacy of DS in the surgical treatment of DSM.
Turkish Neurosurgery, 2010
The study was conducted to compare the clinical effectiveness of FJ injections (FJI) and FJ radio... more The study was conducted to compare the clinical effectiveness of FJ injections (FJI) and FJ radiofrequency (FJRF) denervation in patients with chronic low back pain. mAterIAl and methOds: This study included 100 patients; 50 in FJI 50 in FJRF group. VNS, NASS and EQ-5D were used to evaluate the outcomes. All outcome assessments were performed at baseline, 3 months, 6 months and 12 months. results: FJI in early post-op but FJRF in 1st, 6th and 12th month VNS showed better results (p<0.001). There was no significant difference in the 1st (p=1) and 6th month (p=0.13) but in 12th month (p=0.04) in NASS. Increase in level number showed positive effect in NASS in FJRF group (p=0.018) but no effect in FJI group (p=0.823) in the 12th month follow-up. There was no significant difference with respect to 1st month (p=0.17), 6th month (p=0.22) and 12th month (p=0.11) post-procedure follow-ups in EQ-5D. At the short term FJI was more effective than FJRF however in midterm follow-up FJRF had more satisfying results than FJRF.
Asian Spine Journal, 2012
Study Design: Clinical study. Purpose: The dimensions of the working zone for endoscopic lumbar d... more Study Design: Clinical study. Purpose: The dimensions of the working zone for endoscopic lumbar discectomy should be evaluated by preoperative magnetic resonance images. The aim of this study was to analyze the angle of the roots, root area, and foraminal area. Overview of Literature: Few studies have reported on the triangular working zone during transforaminal endoscopic lumbar discectomy. Many risk factors and restrictions for this procedure have been proposed. Methods: Images of 39 patients were analyzed bilaterally at the levels of L3-L4 and L4-L5. Bilateral axial and coronal angles of the roots, root area, and foraminal area were calculated. Results: No significant difference was observed between the axial angle of the left and right L3 root. A significant difference was found between the axial angle of right and left L4 roots. A significant difference was observed when the coronal angle of the right and left L3 roots were compared, but no significant difference was found when the coronal angle of the right and left L4 roots were compared. No significant difference was observed when the foraminal area of the right and left L3 and L4 roots were compared, but a significant difference was observed when the root area of right and left L3 and L4 roots were compared. Conclusions: We suggest that these radiological measurements should be obtained for safety reasons before endoscopic discectomy surgery.
Childs Nervous System, 2011
Object Spinal column trauma is relatively uncommon in the pediatric population, representing 1–2... more Object Spinal column trauma is relatively uncommon in the pediatric population, representing 1–2% of all pediatric fractures. However, pediatric spinal injury at more than one level is not uncommon. The purpose of this study was to evaluate the mechanisms and patterns of the injury and factors affecting management and outcomes of pediatric multilevel spine injuries. Patients and methods Patients with pediatric spine
Surgical Neurology, 2009
Background: Risks related to rebleeding of a ruptured intracranial aneurysm have decreased. Howev... more Background: Risks related to rebleeding of a ruptured intracranial aneurysm have decreased. However, ischemic neurologic deficits related to vasospasm are still the leading causes of mortality and morbidity. It is well known that vasospasm is a dynamic process affected by various factors. The severity of vasospasm in animal models and clinical observations differ from each other. This variability has not been completely explained by blood and blood degradation products. Therefore, metabolites released from the damaged vessel wall during the bleeding are thought to play an important role in vasospasm. Method: To test this hypothesis, we used 46 male Wistar rats that were divided into 7 groups and administered one of the following to cisterna magna: venous blood, arterial blood, arterial wall homogenate, venous wall homogenate, combined mixture of arterial blood and artery wall homogenate, or combined mixture of venous blood and venous wall homogenate. Brainstems of the rats were excised, and the basilar arteries were harvested for morphometric measurements. Result: There were significant differences between the degree of vasospasm caused by arterial and venous blood (P b .0001). The intraluminal area of the basilar artery was significantly narrower after application of arterial blood, artery wall homogenate, or their combination (49% ± 1%) than after venous groups (30% ± 1.9%) (P b .0001).
Surgical Neurology, 2008
Background: This is a report of 5 patients treated surgically for SCMs. Methods: During the perio... more Background: This is a report of 5 patients treated surgically for SCMs. Methods: During the period from 1998 to 2003, 5 patients (4 male and 1 female) harboring SCMs were treated surgically (all of them underwent complete surgical removal). Patients' ages ranged between 22 and 57 years (mean age, 46 years). Median duration of symptoms was 31 months (1-120 months). Diagnosis was made by MRI scan showing lesions in length of 1 to 6 cm in diameter (mean length, 2.9 cm). Three lesions were found in the cervical, one in the upper dorsal, and one in the lower dorsal cord. One of them was located extradurally, one of them intradural extramedullary, and 3 of them intramedullary. Results: An MRI examination showing total removal was performed postoperatively in each patient (the postoperative MRI examinations revealed total removal in all cases). The follow-up period ranged from 1 to 4 years (mean, 27 months). All patients showed clinical improvement, with 3 of them worsening early in the postoperative period but doing better in long-term follow-up (although 3 of 5 patients had worse neurological examinations in the early postoperative period, all recovered in long-term follow-up and clinically improved relative to preoperative status). Conclusion: Neurological status of the patients can worsen in the early postoperative period, causing intramedullary operation; but it usually improves relative to preoperative status. Surgical removal seems to be a safe and a promising way of treatment of symptomatic SCMs. D
Journal of Neurosurgery: Spine, 2007
The authors undertook a study to explore the topographic anatomical features seen during the ante... more The authors undertook a study to explore the topographic anatomical features seen during the anterolateral approach to cervical spine, anatomical variations, and certain landmarks related to the surgical procedure. The study was conducted in 30 fresh cadavers. The common carotid artery bifurcation was mostly found at the level of C-4 (78%). The inferior belly of the omohyoid muscle was seen to cross the sternocleidomastoid muscle at the C5-6 disc level along the entire C-6 vertebral body. To reach the lower cervical region, the sacrifice of this muscle makes the procedure easier. The facial vein drained into the internal jugular vein mostly at the level of C3-4 (54%). The superior ganglion of the cervical sympathetic chain was located at the C-4 vertebra, but the location of the intermediate ganglion exhibited some variation. The vertebral artery entered the transverse foramen of C-6 in 27 cadavers (90%), the transverse foramen of C-7 in two cadavers (7%), and the transverse foramen of C-4 in one cadaver (3%). Because the inferior thyroid artery crossed the C6-7 interspace obliquely, the course of the inferior thyroid artery may complicate the procedure. The C-5 uncinate process was shortest and narrowest and had the greatest distance from the medial edge of the process to the anterior tubercle (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Understanding the qualitative anatomy of this region not only improves the safety of anterior and anterolateral cervical spine surgery but also allows adequate decompression of neural elements and resolution of the other pathological processes of this region. In this fresh cadaveric study, our goal was to improve the approach and decrease the incidence of complications.
European Spine Journal, 2010
Non-neoplastic intramedullary spinal lesion cases are rarely seen in the literature. We would lik... more Non-neoplastic intramedullary spinal lesion cases are rarely seen in the literature. We would like to present this case for differential diagnosis of intramedullary spinal tumors. The aim of this case report is to attract attention on the MRI findings with lack of contrast enhancement and long syrinx formation which differs these types of lesions from the intramedullary spinal tumors. Intraoperative, pathological and immunohistochemical findings of non-neoplastic intramedullary spinal lesion were discussed.
European Spine Journal, 2008
The sympathetic trunk is sometimes damaged during the anterior and anterolateral approach to the ... more The sympathetic trunk is sometimes damaged during the anterior and anterolateral approach to the cervical spine, resulting in Horner's syndrome. No quantitative regional anatomy in fresh human cadavers describing the course and location of the cervical sympathetic trunk (CST) and its relation to the longus colli muscle (LCM) is available in the literature. The aims of this study are to clearly delineate the surgical anatomy and the anatomical variations of CST with respect to the structures around it and to develop a safer surgical method that will diminish the potential risk of CST injury. In this study, 30 cadavers from the Department of Forensic Medicine were dissected to observe the surgical anatomy of the CST. The cadavers used in this study were fresh cadavers chosen at 12-24 h postmortem. The levels of superior and intermediate ganglions of cervical sympathetic chain were determined. The distance of the sympathetic trunk from the medial border of LCM at C6, the diameter of the CST at C6 and the length and width of the superior and intermediate (middle) cervical ganglion were measured. Cervical sympathetic chain is located posteromedial to carotid sheath and just anterior to the longus muscles. It extends longitudinally from the longus capitis to the longus colli over the muscles and under the prevertebral fascia. The average distance between the CST and medial border of the LCM at C6 is 11.6 ± 1.6 mm. The average diameter of the CST at C6 is 3.3 ± 0.6 mm. Superior ganglion of CSC in all dissections was located at the level of C4 vertebra. The length and width of the superior cervical ganglion were 12.5 ± 1.5 and 5.3 ± 0.6 mm, respectively. The location of the intermediate (middle) ganglion of CST showed some variations. The length and width of the middle cervical ganglion were 10.5 ± 1.3 and 6.3 ± 0.6 mm, respectively. The CST's are at high risk when the LC muscle is cut transversely, or when dissection of the prevertebral fascia is performed. Awareness of the CST's regional anatomy may help the surgeon to identify and preserve it during anterior cervical surgeries.
Neurosurgical Review, 2009
This retrospective study summarizes our experience based on treating 62 patients with trigeminal ... more This retrospective study summarizes our experience based on treating 62 patients with trigeminal neuralgia treated with microvascular decompression. All patients had typical trigeminal neuralgia symptoms, with 24 of them (38%) having failed to benefit from other previous treatment paradigms. We excluded subjects with atypical and/or secondary forms of trigeminal neuralgia. Follow-up duration ranged from 5 months to 10 years 6 months, with recurrence
Neurology India, 2010
Epidural steroid injection (ESIs) is one of the treatment modalities for chronic low back pain (C... more Epidural steroid injection (ESIs) is one of the treatment modalities for chronic low back pain (CLBP) with various degrees of success. We analyzed the efficacy of fluoroscopically guided transforaminal epidural steroid injections (TFESIs) via a preganglionic approach in patients with foraminal stenosis due to lumbar spinal stenosis and lumbar discogenic pain with radiculopathy. We analyzed the data of 40 patients (February 2008 and April 2009) with the diagnosis of CLBP and treated by fluoroscopically guided TFESIs via a preganglionic approach. Patients were followed-up at one month (short term), six months (midterm) and one year (long term) after injections. Follow-up data collection included the Visual Numeric Pain Scale (VNS) and North American Spine Society (NASS) patient satisfaction scores. The mean age of the patients was 59.87 +/- 15.06 years (range 30 - 89 years, 25 women). Average follow-up period was 9.22 +/- 3.56 months. Statistically significant differences were observed between the pre-procedure and post-procedure VNSs (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01, Pearson Correlation Test). Improvements in VNS scores were correlated with improvements in the NASS scores. When the VNS scores were evaluated with respect to the age of patient, level numbers, gender, pre-procedure symptom duration and pre-procedure VNS, no significant differences were found (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05, linear regression test). At short term evaluation in post treatment (one month), 77.78 % of patients were found to have a successful outcome and 22.22 % were deemed failures. Overall patient satisfaction was 67.23 % in the midterm period. Additionally, 54.83 % of patients (N/n: 15/8) had a successful long-term outcome at a follow-up of one year. Our data suggest that fluoroscopically guided TFESIs via a preganglionic approach, in patients with foraminal stenosis due to lumbar spinal stenosis and lumbar discogenic pain with radiculopathy, has effective outcome and patients responding to injection have significantly lower post-injection pain scores.
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES, 2008
Injuries to the spinal accessory nerve are rare and mostly iatrogenic. Pain, impaired ability to ... more Injuries to the spinal accessory nerve are rare and mostly iatrogenic. Pain, impaired ability to raise the ipsilateral shoulder, and scapular winging on abduction of the arm are the most frequently noted clinical manifestations. As a seldom case, a 20 year-old male with spinal accessory nerve palsy after penetrating trauma by gunshot was reported. Three months after the injury, he was complaining about left arm pain in abduction to shoulder level and a decreased range of movement. On physical examination, wasting of the left trapezium with loss of nuchal ridge and drooping of the shoulder were found. On neurological examination of the left trapezius and sternomastoid muscles, motor function were 3/5 and wide dysesthesia on the neck, shoulder and arm was present. The bullet entered just above the clavicle and exited from trapezium. Radiological studies were normal, where electromyography (EMG) showed neuropathic changes. Surgical exploration showed the intact nerve lying on its natur...
Brucellosis is an infectious disease spread by consumption of non-pasteurized milk products or th... more Brucellosis is an infectious disease spread by consumption of non-pasteurized milk products or through contact with infected animals. Spinal involvement is one of the most important complications and the lumbar area is the most frequently affected site. Among the neurological consequences, nerve root compression can be a result of epidural abscess, granuloma or discitis secondary to vertebral body involvement. In this case report we present a 50-year-old male patient with brucellar discitis without spondylitis which caused lumbar disc herniation. We want to emphasize that discitis should also be considered in differential diagnosis of nerve root compression in suspected cases.
Turkish Neurosurgery, 2010
Cancers that metastasize to the cauda equina are uncommon. Only seventeen cases were reported. Th... more Cancers that metastasize to the cauda equina are uncommon. Only seventeen cases were reported. Those from pulmonary squamous cell carcinoma was never been published to our knowledge. mAterIAl and methOds: A 79-year-old male patient presented with low back pain since 1 year and severe sacral pain irradiating to the left leg, paraparesis, urinary dysfunction and leg weakness since one week. results: Preoperative magnetic resonance images of the lumbar spine showed an intradural spinal mass in L2-3 with infiltration of the cauda equina; the lesion measured 13 mm craniocaudally and 11 mm anteroposteriorly, and thus occupied the majority of the intrathecal space at that level. The magnetic resonance images, surgical treatment, and related pathophysiology are reviewed.
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES
Traumatic acute subdural hematoma is the most lethal of all head injuries. In this study, 113 pat... more Traumatic acute subdural hematoma is the most lethal of all head injuries. In this study, 113 patients with the diagnosis of posttraumatic acute subdural hematoma, who were operated between 1998 and 2006, were reviewed retrospectively. Statistical analysis was performed to detect any effects of the variables of age, Glasgow Coma Scale (GCS) score on admission, time interval between the trauma and operation, and abnormality in the pupil reaction on the disease mortality and morbidity. Results obtained in the study are discussed and compared with the related current literature. The overall mortality in 113 patients was 56.6%. According to the results, the most important determinants of the prognosis are GCS score of the patient on admission, abnormality in pupil reaction, timing of the operation, and the patient's age.
Aǧrı : Ağrı (Algoloji) Derneği'nin Yayın organıdır = The journal of the Turkish Society of Algology, 2005
Trigeminal neuralgia is a painful condition of the face characterized by paroxysmal lancinating, ... more Trigeminal neuralgia is a painful condition of the face characterized by paroxysmal lancinating, shock-like pain confined to the somatosensory distribution of the trigeminal nerve. The etiology of most cases of trigeminal neuralgia has been suggested to be vascular compression of the central axons of the trigeminal nerve at the level of pontocerebellar region, so called hyperactive dysfunctional syndrome. Trigeminal neuralgia is the one of the most known pain syndromes. Several neurosurgical procedures have been developed for the treatment of idiopathic trigeminal neuralgia and in this review, idiopathic trigeminal neuralgia was discussed in aspect of different surgical modalities.
No shinkei geka. Neurological surgery, 1982
About a month prior to admission to our hospital, a 25-year-old man had a quarrel with his friend... more About a month prior to admission to our hospital, a 25-year-old man had a quarrel with his friend and was stabbed in his left eye with a cracked bottle of beer. He underwent emergency operation for the injured left eye. Subsequently he was admitted to an ophthalmological ward in our hospital for plastic surgery of an artificial eye. An intracranial foreign body was pointed out, and he was soon transferred to our neurosurgical ward. Plain x-ray films and tomograms of the skull and CT scan showed a foreign body at medial portion of the left superior orbital fissure. Carotid angiography revealed no significant implication of the cerebral vessels. As there was a strong suspicion of cerebral contusion or liquorrhea, a pterional craniotomy was so designed as to do removal of thie foreign body and repair of the dura mater in one stage. The post-operative couse was uneventful without liquorrhea or miningitis. It was emphasized that pterional approach used by Hamby (1970) for surgery of mali...
Early Brain Injury or Cerebral Vasospasm, 2011
the aim of this study was to assess and to compare the ability of intrathecal flunarizine and nim... more the aim of this study was to assess and to compare the ability of intrathecal flunarizine and nimodipine to prevent vasospasm in a rabbit model of subarachnoid hemorrhage (SAH). forty male New Zealand white rabbits were allocated into 5 groups randomly. The treatment groups were as follows: (1) control (no SAH [n = 8]), (2) SAH only (n = 8), (3) SAH plus vehicle (n = 8), (4) SAH plus nimodipine (n = 8), and (5) SAH plus flunarizine (n = 8). Before sacrifice, all animals underwent femoral artery catheterization procedure by open surgery under anesthesia and angiography performed for each animal. there was a statistically significant difference between the mean basilar artery cross-sectional areas and the mean arterial wall thickness measurements of the control and SAH-only groups (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Basilar artery vessel diameter and luminal section areas in group 4 were significantly higher than in group 2 (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Basilar artery vessel diameter and basilar artery luminal section areas in group 5 were significantly higher than in group 2 (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05).Basilar artery vessel diameter and basilar artery luminal section areas in group 5 were significantly higher than in group 4 (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). these findings demonstrate that flunarizine has marked vasodilatatory effect in an experimental model of SAH in rabbits.
Early Brain Injury or Cerebral Vasospasm, 2011
the aim of this study was to assess and to compare the ability of intrathecal nicergoline and nim... more the aim of this study was to assess and to compare the ability of intrathecal nicergoline and nimodipine in prevention of cerebral vasospasm in a rabbit model of subarachnoid hemorrhage (SAH). twenty male New Zealand white rabbits were allocated into four groups randomly. Subarachnoid hemorrhage was induced by injecting autologous blood into the cisterna magna. The treatment groups were as follows: (1) control [no SAH (n = 5)], (2) SAH only (n = 5), (3) SAH plus nimodipine (n = 5), and (4) SAH plus nicergoline (n = 5). there was a statistically significant difference between the mean basilar artery cross-sectional areas and the mean arterial wall thickness measurements of the control and SAH-only groups (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Basilar artery vessel diameter and luminal section areas in group 3 were significantly higher than in group 2 (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Basilar artery vessel diameter and basilar artery luminal section areas in group 4 were significantly higher than in group 2 (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). There was no significant difference between basilar artery vessel diameter and basilar artery luminal section areas in group 3 and group 4. these findings demonstrate that intrathecal nicergoline has a vasodilatatory effect in an experimental model of SAH in rabbits but not more than that of nimodipine.
Turkish Neurosurgery, 2014
AIm: This study was aimed to investigate the variations in the spinal nerve root compositions of ... more AIm: This study was aimed to investigate the variations in the spinal nerve root compositions of musculocutaneous nerve and to confirm which spinal nerve root is the main ingredient in participating amount. mATERIAl and mEThods: A total of 20 fresh cadavers were dissected. Brachial plexus and its branches were extracted. Musculocutaneous nerve stump was traced back to the roots to identify its fascicular origin. The number of fascicles originating from a particular nerve root and their axial location with in the nerve were noted.
World Neurosurgery, 2011
To determine the suitability of the application of dynamic stabilization (DS) as a nonfusion tech... more To determine the suitability of the application of dynamic stabilization (DS) as a nonfusion technique to address dysfunctional segmental motion (DSM) in the lumbar spine. Over a 1-year period, 25 patients were treated with the same assessment and surgical protocol. Inclusion criteria were clinical presentation of DSM with or without stenosis. On preoperative and postoperative plain anteroposterior, lateral, and lateral flexion-extension radiographs, anterior and posterior disc height (DH); anteroposterior diameter of the disc; and global, segmental, apical segment, and below level lordotic angles (LAs) were measured. The study included 9 women and 16 men with a mean age of 43.48 years ± 7.6. On average, patients had symptoms for 38.04 months ± 29.6, and mean follow-up was 12.36 months ± 3.46. The average height of anterior, posterior, and mean intervertebral discs increased significantly (P = 0.002, P = 0.003, and P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). There were no significant differences between the preoperative and postoperative global, segmental, apical segment, and below segment LAs in flexion, extension, and neutral positions. At mid-term follow-up, no patients showed new signs of degeneration at the adjacent motion segment. Overall, the limited radiologic data advocate DS as a nonfusion technique in the treatment of DSM in the lumbar spine. Long-term follow-up is essential, however, to investigate the long-term efficacy of DS in the surgical treatment of DSM.
Turkish Neurosurgery, 2010
The study was conducted to compare the clinical effectiveness of FJ injections (FJI) and FJ radio... more The study was conducted to compare the clinical effectiveness of FJ injections (FJI) and FJ radiofrequency (FJRF) denervation in patients with chronic low back pain. mAterIAl and methOds: This study included 100 patients; 50 in FJI 50 in FJRF group. VNS, NASS and EQ-5D were used to evaluate the outcomes. All outcome assessments were performed at baseline, 3 months, 6 months and 12 months. results: FJI in early post-op but FJRF in 1st, 6th and 12th month VNS showed better results (p<0.001). There was no significant difference in the 1st (p=1) and 6th month (p=0.13) but in 12th month (p=0.04) in NASS. Increase in level number showed positive effect in NASS in FJRF group (p=0.018) but no effect in FJI group (p=0.823) in the 12th month follow-up. There was no significant difference with respect to 1st month (p=0.17), 6th month (p=0.22) and 12th month (p=0.11) post-procedure follow-ups in EQ-5D. At the short term FJI was more effective than FJRF however in midterm follow-up FJRF had more satisfying results than FJRF.
Asian Spine Journal, 2012
Study Design: Clinical study. Purpose: The dimensions of the working zone for endoscopic lumbar d... more Study Design: Clinical study. Purpose: The dimensions of the working zone for endoscopic lumbar discectomy should be evaluated by preoperative magnetic resonance images. The aim of this study was to analyze the angle of the roots, root area, and foraminal area. Overview of Literature: Few studies have reported on the triangular working zone during transforaminal endoscopic lumbar discectomy. Many risk factors and restrictions for this procedure have been proposed. Methods: Images of 39 patients were analyzed bilaterally at the levels of L3-L4 and L4-L5. Bilateral axial and coronal angles of the roots, root area, and foraminal area were calculated. Results: No significant difference was observed between the axial angle of the left and right L3 root. A significant difference was found between the axial angle of right and left L4 roots. A significant difference was observed when the coronal angle of the right and left L3 roots were compared, but no significant difference was found when the coronal angle of the right and left L4 roots were compared. No significant difference was observed when the foraminal area of the right and left L3 and L4 roots were compared, but a significant difference was observed when the root area of right and left L3 and L4 roots were compared. Conclusions: We suggest that these radiological measurements should be obtained for safety reasons before endoscopic discectomy surgery.
Childs Nervous System, 2011
Object Spinal column trauma is relatively uncommon in the pediatric population, representing 1–2... more Object Spinal column trauma is relatively uncommon in the pediatric population, representing 1–2% of all pediatric fractures. However, pediatric spinal injury at more than one level is not uncommon. The purpose of this study was to evaluate the mechanisms and patterns of the injury and factors affecting management and outcomes of pediatric multilevel spine injuries. Patients and methods Patients with pediatric spine
Surgical Neurology, 2009
Background: Risks related to rebleeding of a ruptured intracranial aneurysm have decreased. Howev... more Background: Risks related to rebleeding of a ruptured intracranial aneurysm have decreased. However, ischemic neurologic deficits related to vasospasm are still the leading causes of mortality and morbidity. It is well known that vasospasm is a dynamic process affected by various factors. The severity of vasospasm in animal models and clinical observations differ from each other. This variability has not been completely explained by blood and blood degradation products. Therefore, metabolites released from the damaged vessel wall during the bleeding are thought to play an important role in vasospasm. Method: To test this hypothesis, we used 46 male Wistar rats that were divided into 7 groups and administered one of the following to cisterna magna: venous blood, arterial blood, arterial wall homogenate, venous wall homogenate, combined mixture of arterial blood and artery wall homogenate, or combined mixture of venous blood and venous wall homogenate. Brainstems of the rats were excised, and the basilar arteries were harvested for morphometric measurements. Result: There were significant differences between the degree of vasospasm caused by arterial and venous blood (P b .0001). The intraluminal area of the basilar artery was significantly narrower after application of arterial blood, artery wall homogenate, or their combination (49% ± 1%) than after venous groups (30% ± 1.9%) (P b .0001).
Surgical Neurology, 2008
Background: This is a report of 5 patients treated surgically for SCMs. Methods: During the perio... more Background: This is a report of 5 patients treated surgically for SCMs. Methods: During the period from 1998 to 2003, 5 patients (4 male and 1 female) harboring SCMs were treated surgically (all of them underwent complete surgical removal). Patients' ages ranged between 22 and 57 years (mean age, 46 years). Median duration of symptoms was 31 months (1-120 months). Diagnosis was made by MRI scan showing lesions in length of 1 to 6 cm in diameter (mean length, 2.9 cm). Three lesions were found in the cervical, one in the upper dorsal, and one in the lower dorsal cord. One of them was located extradurally, one of them intradural extramedullary, and 3 of them intramedullary. Results: An MRI examination showing total removal was performed postoperatively in each patient (the postoperative MRI examinations revealed total removal in all cases). The follow-up period ranged from 1 to 4 years (mean, 27 months). All patients showed clinical improvement, with 3 of them worsening early in the postoperative period but doing better in long-term follow-up (although 3 of 5 patients had worse neurological examinations in the early postoperative period, all recovered in long-term follow-up and clinically improved relative to preoperative status). Conclusion: Neurological status of the patients can worsen in the early postoperative period, causing intramedullary operation; but it usually improves relative to preoperative status. Surgical removal seems to be a safe and a promising way of treatment of symptomatic SCMs. D
Journal of Neurosurgery: Spine, 2007
The authors undertook a study to explore the topographic anatomical features seen during the ante... more The authors undertook a study to explore the topographic anatomical features seen during the anterolateral approach to cervical spine, anatomical variations, and certain landmarks related to the surgical procedure. The study was conducted in 30 fresh cadavers. The common carotid artery bifurcation was mostly found at the level of C-4 (78%). The inferior belly of the omohyoid muscle was seen to cross the sternocleidomastoid muscle at the C5-6 disc level along the entire C-6 vertebral body. To reach the lower cervical region, the sacrifice of this muscle makes the procedure easier. The facial vein drained into the internal jugular vein mostly at the level of C3-4 (54%). The superior ganglion of the cervical sympathetic chain was located at the C-4 vertebra, but the location of the intermediate ganglion exhibited some variation. The vertebral artery entered the transverse foramen of C-6 in 27 cadavers (90%), the transverse foramen of C-7 in two cadavers (7%), and the transverse foramen of C-4 in one cadaver (3%). Because the inferior thyroid artery crossed the C6-7 interspace obliquely, the course of the inferior thyroid artery may complicate the procedure. The C-5 uncinate process was shortest and narrowest and had the greatest distance from the medial edge of the process to the anterior tubercle (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Understanding the qualitative anatomy of this region not only improves the safety of anterior and anterolateral cervical spine surgery but also allows adequate decompression of neural elements and resolution of the other pathological processes of this region. In this fresh cadaveric study, our goal was to improve the approach and decrease the incidence of complications.
European Spine Journal, 2010
Non-neoplastic intramedullary spinal lesion cases are rarely seen in the literature. We would lik... more Non-neoplastic intramedullary spinal lesion cases are rarely seen in the literature. We would like to present this case for differential diagnosis of intramedullary spinal tumors. The aim of this case report is to attract attention on the MRI findings with lack of contrast enhancement and long syrinx formation which differs these types of lesions from the intramedullary spinal tumors. Intraoperative, pathological and immunohistochemical findings of non-neoplastic intramedullary spinal lesion were discussed.
European Spine Journal, 2008
The sympathetic trunk is sometimes damaged during the anterior and anterolateral approach to the ... more The sympathetic trunk is sometimes damaged during the anterior and anterolateral approach to the cervical spine, resulting in Horner's syndrome. No quantitative regional anatomy in fresh human cadavers describing the course and location of the cervical sympathetic trunk (CST) and its relation to the longus colli muscle (LCM) is available in the literature. The aims of this study are to clearly delineate the surgical anatomy and the anatomical variations of CST with respect to the structures around it and to develop a safer surgical method that will diminish the potential risk of CST injury. In this study, 30 cadavers from the Department of Forensic Medicine were dissected to observe the surgical anatomy of the CST. The cadavers used in this study were fresh cadavers chosen at 12-24 h postmortem. The levels of superior and intermediate ganglions of cervical sympathetic chain were determined. The distance of the sympathetic trunk from the medial border of LCM at C6, the diameter of the CST at C6 and the length and width of the superior and intermediate (middle) cervical ganglion were measured. Cervical sympathetic chain is located posteromedial to carotid sheath and just anterior to the longus muscles. It extends longitudinally from the longus capitis to the longus colli over the muscles and under the prevertebral fascia. The average distance between the CST and medial border of the LCM at C6 is 11.6 ± 1.6 mm. The average diameter of the CST at C6 is 3.3 ± 0.6 mm. Superior ganglion of CSC in all dissections was located at the level of C4 vertebra. The length and width of the superior cervical ganglion were 12.5 ± 1.5 and 5.3 ± 0.6 mm, respectively. The location of the intermediate (middle) ganglion of CST showed some variations. The length and width of the middle cervical ganglion were 10.5 ± 1.3 and 6.3 ± 0.6 mm, respectively. The CST's are at high risk when the LC muscle is cut transversely, or when dissection of the prevertebral fascia is performed. Awareness of the CST's regional anatomy may help the surgeon to identify and preserve it during anterior cervical surgeries.
Neurosurgical Review, 2009
This retrospective study summarizes our experience based on treating 62 patients with trigeminal ... more This retrospective study summarizes our experience based on treating 62 patients with trigeminal neuralgia treated with microvascular decompression. All patients had typical trigeminal neuralgia symptoms, with 24 of them (38%) having failed to benefit from other previous treatment paradigms. We excluded subjects with atypical and/or secondary forms of trigeminal neuralgia. Follow-up duration ranged from 5 months to 10 years 6 months, with recurrence