mustafa bozbuga - Academia.edu (original) (raw)
Papers by mustafa bozbuga
Pediatric Neurosurgery, 2006
tracted from the study group, intracranial lesions were noted in 4.1% of the cases, and in 1.8% n... more tracted from the study group, intracranial lesions were noted in 4.1% of the cases, and in 1.8% neurosurgical intervention was required. Computed tomography is the gold standard in the evaluation of pediatric patients with mild head trauma, and every child who has experienced a head injury should undergo a cranial computed tomography evaluation, even if he or she appears in perfect health.
PubMed, Jul 1, 2002
We report herein two patients in whom bullets migrated into adjacent lateral ventricles in the br... more We report herein two patients in whom bullets migrated into adjacent lateral ventricles in the brain and moved freely as a consequence of gravity. A rewiew ofthe literature suggests that spontaneous migration ofintracerebral bullets is being eased by cerebral softness, specific gravity of the bullet compared with brain tissue. ln patients undergoing the surgical removal of intracerebral or intraventricular bullets, an x-ray is recommended after final positioning.
Neurosurgical Review, Mar 1, 1998
Most of the numerous experimental studies to research pathophysiological changes following acute ... more Most of the numerous experimental studies to research pathophysiological changes following acute spinal cord injury suggest a two-step mechanism of damage to the spinal cord in which the primary (direct) or mechanical injury caused by the trauma initiates secondary (indirect) or progressive autodestructive injury of the cord. During recent years, free oxygen radical generation and lipid peroxidation have been considered to be responsible for secondary autodestructive injury. Alpha tocopherol occupies an important and unique position in the overall antioxidant defense. Alpha tocopherol-depleted animals are generally more susceptible to the adverse effects of environmental agents than are supplemented animals. This study was planned to study the effectiveness in counteracting this autodestructive process by supplementing alpha-tocopherol in rats maintained on a nutritionally adequate diet, and also to evaluate whether it will provide additional protection or not. Eighty healthy Wistar rats (treatment and controls) were included. The treatment group received 100 mg/kg alpha tocopherol each day, intraperitoneally for seven days. Using a standard acute spinal cord trauma model in Wistar rats trauma was applied, an malondialdehyde (MDA) which is a lipid peroxidation product was measured in the traumatized spinal cord at various times following the trauma in order to indirectly evaluate the lipid peroxidation and generation of free oxygen radicals in a time sequence. Statistical analysis of the values demonstrated that malondialdehyde formation in the alpha-tocopherol administered group was significantly lower than in the control group. These findings indicate that longterm administration of alpha-tocopherol may be useful to decrease lipid peroxidation following acute spinal cord trauma.
Neurosurgery, Jul 1, 2005
Although rare in developed countries, hydatid disease is a serious parasitic infection in endemic... more Although rare in developed countries, hydatid disease is a serious parasitic infection in endemic areas. Spinal disease most commonly involves the thoracic region, and involvement of the upper cervical spine is extremely rare. In this report, a case of hydatid disease involving the craniocervical junction is presented, along with a review of the literature. CLINICAL PRESENTATION: A 44-year-old man presented with the complaint of neck pain. The results of his physical and neurological examinations were within normal ranges, except for pain exacerbated by neck motion and spasm of the cervical musculature. Magnetic resonance imaging demonstrated a cystic lesion involving the odontoid process and body of C1 and C2, with thin and regular cyst walls and cyst contents similar in intensity to that of cerebrospinal fluid. The results of serological tests performed with the suspected diagnosis of hydatid disease were positive. INTERVENTION: The patient initially underwent surgery to provide stabilization of the craniocervical junction, using autogenous bone graft and sublaminar wiring from the occiput to C3 via a posterior approach. The cyst was approached via a transoral route, using a U-shaped pharyngeal incision. There were no neurological deficits after surgery. Postoperative magnetic resonance imaging scans confirmed complete excision of the cyst, and the patient was discharged on the 12th postoperative day. He received six cycles of albendazole treatment, each consisting of 28 days with an intervening drug-free period of 2 weeks. Magnetic resonance imaging scans performed 1 year after surgery revealed the patient was still disease-free. CONCLUSION: Hydatid disease should be considered in the differential diagnosis of spinal cord compression, especially in endemic areas. Although the chance of obtaining a cure is unlikely, radical surgery coupled with antihelminthic therapy seems to provide long-lasting relief.
PubMed, 2010
Aim: Knowing the location of the transverse sinus in the midline supracerebellar infratentorial a... more Aim: Knowing the location of the transverse sinus in the midline supracerebellar infratentorial approach is important to prevent its inadvertent injury. The external landmarks of the occipital bone have been studied in this anatomic study in order to reveal their relationship with the transverse sinus. Material and methods: Fifty-two dried skulls were used to study the relationship of the transverse sinus with various surface bone structures. The key bone surface structures identified in each specimen were the superior nuchal line, the inferior nuchal line, the inion, internal occipital protuberance, and the transverse sulcus. Results: The distance from the inion to the inferior nuchal line in specimens ranged from 12.7 mm to 37.7 mm. The distance from the inferior nuchal line to the midline foramen magnum in the specimens ranged from 19 mm to 34.75 mm. The width of the proximal transverse sulcus ranged from 2.6 mm to 10.16 mm with an average of 6.43 mm on the right side and 3.4 mm to 10.6 mm with an average of 6.15 mm on the left. Conclusion: The first and most superior burr hole for midline supracerebellar infratentorial approach can be safely placed approximately 1 cm below the inferior nuchal line. A burr hole in this localization will avoid the transverse sinus.
PubMed, Apr 1, 2009
Primary spinal hydatid disease is rare. Spinal hydatid disease should be considered in the differ... more Primary spinal hydatid disease is rare. Spinal hydatid disease should be considered in the differential diagnosis of spinal cord compression syndrome in endemic countries and evaluated with imaging and serology. Our case was a 34- year-old man. The patient presented with progressive back pain for 8 months and lower extremity weakness for 3 months. Neurological examination was suggestive of upper motor neuron type of paraperesis. Magnetic resonance images of the thoracal region showed an intradural multicystic lesion. The mass was explored with T 10-11 laminectomy. It had displaced the cord to the right side. The fluid was clear and did not contain pus. The lesion was easily dissected from the cord and was resected totally. The pathological diagnosis was hydatid disease.
PubMed, 2007
Extensive and aggressive surgical removal is treatment of choice for patients who have chordomas ... more Extensive and aggressive surgical removal is treatment of choice for patients who have chordomas of the cranial base. Well-developed microsurgical techniques, as well as good surgical judgment learned from experience are essential to avoid major morbidity. A 14-year-old female presented with progressive headaches and diplopia for three months. Cranial magnetic resonance imaging demonstrated a well-circumscribed mass in the clival region. The mass was totally excised via right combined pterional transsylvian and anterior temporal approach (+ orbitozygomatic osteotomy). The tumor was located extradurally. The resected tumor had the typical histological and immunohistochemical characteristics of chordoma. No radiation therapy or chemotherapy was administered.
PubMed, 2008
Cranial bone and epidural tuberculosis is rare manifestation extrapulmonary tuberculosis. The inc... more Cranial bone and epidural tuberculosis is rare manifestation extrapulmonary tuberculosis. The incidence of tuberculosis of calvaria is on the rise in developing countries because of malnutrition, poor socioeconomic conditions, and immunodeficiency. We present the clinical features, radiology, histopathology, and surgical findings of a case of tuberculosis of the frontal bone with epidural extension. A 46 year-old female had presented with a history of painless right frontal swelling for the previous 4 months. The patient was operated on at a peripheral center for swelling in the right frontal region. In postoperative period, a leak that did not reply to nonspecific antibiotic therapy developed on the lesion. Right frontal epidural effusion was found in the patient who presented our clinic. Histopathological and microbiological examination suggested a diagnosis of tuberculosis.
PubMed, Apr 1, 2009
An aneurysmal bone cyst (ABC) typically involves the long bones of the extremities, thorax, pelvi... more An aneurysmal bone cyst (ABC) typically involves the long bones of the extremities, thorax, pelvis, or vertebrae. Skull base involvement is rare. We describe the case of a 9-year-old girl with ABC of the skull base. The patient had presented with nasal obstruction and headache over a period of approximately 8 months. The patient had no history of trauma or surgery. Physical and neurological examination findings normal. Magnetic resonance imaging (MRI) showed a multicystic lesion arising from the sphenoid sinus and extending into ethmoid sinus, superior nasal cavity and medial walls of the orbit. The lesion contained thin internal septations that revealed high signal characteristics on all sequences. The lesion was resected via an extended frontal approach without any complications. Histological evaluation confirmed that the lesion was an ABC. The patient did not receive postoperative radiotherapy. No recurrence was observed after 22 months. ABC should be considered in the differential diagnosis of bone neoplasms in this region.
Turkish Neurosurgery, 2009
The primary brain tumors associated with cerebral aneurysms are rare in neurosurgical practice. T... more The primary brain tumors associated with cerebral aneurysms are rare in neurosurgical practice. The present article constitutes an evaluation of the management of coexistent primary brain tumor and cerebral aneurysm. A retrospective study of three cases of primary brain tumor with cerebral aneurysm was performed. We evaluated the complications and clinic outcomes by assessing the clinical and imaging findings. Case 1 presented with a subarachnoid hemorrhage from an aneurysm of the anterior communicating artery, with an incidental left frontal oligodendroglioma. Case 2 presented with chronic headache due to left frontal convexity meningioma, with proximal internal carotid artery aneurysm which was found incidentally during preoperative magnetic resonance angiography. Case 3 was admitted to our hospital complaining of headache, memory disturbance, and weakness in her left lower extremity. Magnetic resonance imaging revealed right frontal lymphoma and an unruptured aneurysm at the left middle cerebral artery. Preoperative magnetic resonance imaging revealed right frontal lymphoma and unruptured left middle cerebral artery. The frequency of primary brain tumor and cerebral aneurysm coexistence is increasing due to improvements in high-resolution imaging. In these complicated cases, the management will differ according to each pathology present, and this is an important problem for a neurosurgeon.
Turkish Neurosurgery, 2010
Tuberculosis has been an important public health problem in both developing and develop nations. ... more Tuberculosis has been an important public health problem in both developing and develop nations. Tuberculosis of the central nervous system is rare. Tuberculosis meningitis and tuberculoma are the two most important manifestations of tuberculosis of the CNS. Intracranial tuberculomas may be solitary or multiple. Solitary tuberculomas may be indistinguishable from cranial abscess or primary brain tumor. It is necessary to rule out tuberculoma in patients with intracranial mass lesions. We present a case of tuberculoma mimicking a high grade glial tumor on magnetic resonance imaging and clinical presentation. A 30-year-old woman presented with one-month history of epilepsy. Cranial magnetic resonance imaging showed a left occipital peripheral ring-enhanced lesion with central necrosis. There was a strong suspicion of glial tumor. The lesion was totally excised with left occipital craniotomy. Histological examination of mass revealed a tuberculoma. The patient was treated with antituberculous chemotherapy.
Turkish journal of trauma & emergency surgery, Jul 1, 2005
Ateşli silahla başlarından yaralanmaları nedeniyle hastanemizde tedavisi yapılan sivil hastalarda... more Ateşli silahla başlarından yaralanmaları nedeniyle hastanemizde tedavisi yapılan sivil hastalarda tedavi şekilleri dikkate alınmaksızın 7 günlük sağkalımı etkileyen faktörler istatistiksel olarak incelenerek GKS, pupilla defekti, koagülopati, intraventriküler penetrasyon, tutulan hemisfer sayısı gibi faktörlerin prognoz üzerine etkileri ortaya konmaya çalışıldı. GEREÇ VE YÖNTEM Hastalar tedavi şekilleri dikkate alınmaksızın yaralanmayı izleyen 7 gün içinde toplam mortaliteleri yönünden iki gruba ayrıldı. Başlangıç Glasgow Koma Skoru (GKS), pupillanın ışık cevabı, koagülopati, ventriküler penetrasyon ve tutulan hemisfer sayısından oluşan toplam 5 değişkenin ayrı ayrı ve birlikte 7 günlük mortalite üzerine olan etkileri ve istatistiksel anlamlılıkları araştırıldı. BULGULAR Çalışma grubundaki 48 hastanın 36' sı (%75'i) erkek, 12' si (%25'i) kadındı. Çalışma grubumuzda toplam sağkalım oranı %27 (13/48), 7 günlük sağkalım oranı % 31 (15/48) olarak saptanmıştır. GKS, pupilla defekti, koagülopati, intraventriküler penetrasyon, tutulan hemisfer sayısını içeren değişkenlerden 7 günden kısa sağkalımı olanlarda mortalite üzerine en yüksek etkinin öncelikle koagülopati daha sonra da pupilla defekti ile olduğu saptanmıştır. Diğer değişkenler mortalite üzerine anlamlı ölçüde etkili olmayıp sonuçlar literatürle paralellik göstermiştir. SONUÇ Ateşli silahlarla başlarından yaralanmış hastalarda pupilla defekti ve koagülopati prognoz tahmininde istatistiksel olarak anlamlı bulunmuştur. Nörolojik durumu kötü bile olsa bu tür hastalarda agresif medikal ve cerrahi tedavinin faydalı olacağı düşüncesindeyiz. Anahtar sözcükler: koagülopati, pupilla defekti, prognoz, sivil kranyal ateşli silah yaralanması. BACKGROUND Patients with civil cranial gunshot injuries who were treated in our hospital were statistically analized for the factors acting on 7 days survival and prognosis without regarding treatment modalities. MATERIAL AND METHOD Patients were divided into two groups according to the mortality rates in 7 days following the trauma without regarding treatment modalities. Initial GCS score, pupillary response to light, coagulopathy, ventricular penetration and number of hemispheres affected are 5 differentials evaluated separately and in combination for their effects on mortality rates within 7 days posttraumatically and their statistical significance. RESULTS Thirty six male (75%) and 12 female (25%) patients included in the study. Total and 7 day-survival rates were 27% (13/48), and 31% (15/48) respectively. Among GCS scores, pupillary defects, coagulopathy, intraventricular penetration, the number of hemispheres affected, the most important prognostic factors of the patients living less than 7 days were found to be primarily coagulopathy and then pupillary defects. The other variables were not significantly effective and the results were in accordance with the literature. CONCLUSION In civilian patients with cranial gunshot injuries pupillary defect and coagulopathy were statistically significant prognostic factors. We think that agressive medical and surgical treatment will be beneficial even if the patients' neurological status is deteriorating.
Rivista Di Neuroradiologia, Nov 27, 2019
Medulloblastoma (MB) that arises outside the cerebellum from cells of the dorsal brainstem is rar... more Medulloblastoma (MB) that arises outside the cerebellum from cells of the dorsal brainstem is rare. The most common subtype of MB in the dorsal brainstem is the Wingless (WNT) subtype that contains activating mutations in the WNT pathway effector CTNNB1. Ipsilateral cerebellar hemi-atrophy with a brainstem tumour is a finding that is usually documented with brainstem gangliogliomas as a possible specific imaging sign. We present a case of a 23-year-old female with progressive headache, imbalance on walking, double vision and difficulty in swallowing for a year. Magnetic resonance imaging demonstrated a mass with prominent restricted diffusion on the dorsal surface of the lower brainstem with ipsilateral cerebellar atrophy. The final histopathological diagnosis was a Sonic Hedgehog (SHH)-activated and TP53 wild-type primary lower dorsal brainstem MB. Primary SHH-activated TP53 wild-type dorsal brainstem MB is extremely rare, and as far as we know, the association of the tumour with ipsilateral cerebellar hemi-atrophy in an adult has never been reported. MB should be included in the differential diagnosis of focal dorsal brainstem tumours, even in the presence of ipsilateral cerebellar hemi-atrophy.
Neurology India, 2010
Lhermitte-Duclos disease (LDD) is a pathologic entity with progrediating, diffuse hypertrophy chi... more Lhermitte-Duclos disease (LDD) is a pathologic entity with progrediating, diffuse hypertrophy chiefly of the stratum granulosum of the cerebellum. Typically LDD is a unilateral lesion of the cerebellum or in vermis. Here we report a case of LDD with bilateral lesions of cerebellar hemispheres managed surgically. A 28-year-old woman presented with one-year history of progressive headache, nausea, vomiting, and blurred vision. Neurologic examination revealed a bilateral mild papilledema, mild dysmetria, and dysdiadochokinesia. The cerebellar lesions caused moderate mass effect in posterior fossa with hydrocephalus, and Chiari type I malformation. We performed the suboccipital-retrosigmoid approach, and removed completely the left intracerebellar mass. Symptoms related to elevated intracranial pressure disappeared in a short period postoperatively.
Neurosurgical Review, Apr 5, 1999
The posterior fossa is an uncommon site for epidural hematomas. Clinical progress is silent and s... more The posterior fossa is an uncommon site for epidural hematomas. Clinical progress is silent and slow, but the deterioration is sudden and quick to become fatal if not promptly treated. Early recognition is therefore extremely important. The recommended treatment for posterior fossa epidural hematoma is surgical evacuation soon after the diagnosis, since the posterior fossa contains vital structures. However, conservative management under close clinical and radiological supervision can be applied in patients without mass effect. In our study, a review of 73 cases with posterior fossa epidural hematoma among a total number of 737 patients with epidural hematoma is presented, and a new neuroradiological classification is proposed in order to determine the appropriate type of treatment. In this series, 14 patients were treated conservatively, while 59 required surgery. The conservatively treated 9 pediatric and 5 adult patients, and 51 of the 59 surgically treated cases, in other words a total of 65 of the 73 patients, showed excellent recovery; 4 patients treated surgically had a moderate disability, and 4 patients died (overall mortality 5.4%). The critical factors influencing outcome were the neuroradiological class, the level of consciousness just before the operation, and the other systemic and/or intracranial traumatic lesions. In this study, the critical observation was that the neuroradiological findings were earlier, more reliable and predictive than the clinical findings. Therefore, based upon the obliteration of perimesencephalic cisterns and/or displacement of the fourth ventricle, a new neuroradiological classification was designed for decision-making in management.
Sinir sistemi cerrahisi dergisi, May 2, 2014
Surgical treatment of posterior circulation aneurysms is more difficult than surgical treatment o... more Surgical treatment of posterior circulation aneurysms is more difficult than surgical treatment of anterior circulation aneurysms and poses a greater technical challenge for the practicing neurosurgeon. There are different surgical options available for the surgical treatment of posterior circulation aneurysms despite the use of the pterional approach to anterior circulation aneurysms. We present our surgical experiences with three cases of posterior circulation aneurysms. Three cases of posterior circulation aneurysms were treated by surgical clipping. We preferred pterional approach for posterior cerebral artery aneurysms, infratentorial supracerebellar approach for superior cerebellar aneurysm, and the combined lateral supracerebellar infratentorial retrosigmoid approach for vertebrobasilar junction aneurysm. The morbidity and mortality associated with open surgery for posterior circulation aneurysms are higher because of the location of the aneurysms within the posterior fossa. For neurosurgeons, the surgical treatment of posterior circulation aneurysms can be challenging.
European Journal of Radiology, Nov 1, 2011
Meningiomas are generally benign masses, and in many cases they do not invade the brain. Therefor... more Meningiomas are generally benign masses, and in many cases they do not invade the brain. Therefore their potential to provide cures is high. The most important cause of the development of recurrence in the post-operative period is subtotal resection. Any information that will allow us to perform total mass resection will be beneficial in terms of long-term good clinical procedure. Our aim in this study is to obtain the radiological data from which we can obtain accurate information in terms of the surgical cleavage between the tumor and parenchyma during the surgical planning of the meningiomas. We evaluated 85 cases with intracranial meningioma that were treated by the same microsurgical technique. All posterior fossa and skull base meningiomas were not included in the study. Tumor size was smaller than 3 cm in 19 cases, between 3 and 6 cm in 46 cases, and bigger than 6 cm in 20 cases. The cleavage line between the tumor capsule and the cortex underneath was extrapial in 32 cases, subpial in 29 cases, and mixed in 24 cases. Dominant arterial supply was dural in 46 cases. Thirty-three cases were predominantly mixed and 6 cases were predominantly corticopial. At magnetic resonance images, 16 of 28 cases which showed clear tumor-cortex interface, had an extrapial cleavage line. When surgical treatment of intracranial meningiomas are considered, it is necessary to examine if there is a surgically safe border between the cortex underneath in the preoperative images. It can be concluded that it is appropriate to operate small meningiomas which are on the sensitive regions of the brain when they are in their earlier stages and still have an extrapial cleavage.
Pediatric Neurosurgery, 2006
tracted from the study group, intracranial lesions were noted in 4.1% of the cases, and in 1.8% n... more tracted from the study group, intracranial lesions were noted in 4.1% of the cases, and in 1.8% neurosurgical intervention was required. Computed tomography is the gold standard in the evaluation of pediatric patients with mild head trauma, and every child who has experienced a head injury should undergo a cranial computed tomography evaluation, even if he or she appears in perfect health.
PubMed, Jul 1, 2002
We report herein two patients in whom bullets migrated into adjacent lateral ventricles in the br... more We report herein two patients in whom bullets migrated into adjacent lateral ventricles in the brain and moved freely as a consequence of gravity. A rewiew ofthe literature suggests that spontaneous migration ofintracerebral bullets is being eased by cerebral softness, specific gravity of the bullet compared with brain tissue. ln patients undergoing the surgical removal of intracerebral or intraventricular bullets, an x-ray is recommended after final positioning.
Neurosurgical Review, Mar 1, 1998
Most of the numerous experimental studies to research pathophysiological changes following acute ... more Most of the numerous experimental studies to research pathophysiological changes following acute spinal cord injury suggest a two-step mechanism of damage to the spinal cord in which the primary (direct) or mechanical injury caused by the trauma initiates secondary (indirect) or progressive autodestructive injury of the cord. During recent years, free oxygen radical generation and lipid peroxidation have been considered to be responsible for secondary autodestructive injury. Alpha tocopherol occupies an important and unique position in the overall antioxidant defense. Alpha tocopherol-depleted animals are generally more susceptible to the adverse effects of environmental agents than are supplemented animals. This study was planned to study the effectiveness in counteracting this autodestructive process by supplementing alpha-tocopherol in rats maintained on a nutritionally adequate diet, and also to evaluate whether it will provide additional protection or not. Eighty healthy Wistar rats (treatment and controls) were included. The treatment group received 100 mg/kg alpha tocopherol each day, intraperitoneally for seven days. Using a standard acute spinal cord trauma model in Wistar rats trauma was applied, an malondialdehyde (MDA) which is a lipid peroxidation product was measured in the traumatized spinal cord at various times following the trauma in order to indirectly evaluate the lipid peroxidation and generation of free oxygen radicals in a time sequence. Statistical analysis of the values demonstrated that malondialdehyde formation in the alpha-tocopherol administered group was significantly lower than in the control group. These findings indicate that longterm administration of alpha-tocopherol may be useful to decrease lipid peroxidation following acute spinal cord trauma.
Neurosurgery, Jul 1, 2005
Although rare in developed countries, hydatid disease is a serious parasitic infection in endemic... more Although rare in developed countries, hydatid disease is a serious parasitic infection in endemic areas. Spinal disease most commonly involves the thoracic region, and involvement of the upper cervical spine is extremely rare. In this report, a case of hydatid disease involving the craniocervical junction is presented, along with a review of the literature. CLINICAL PRESENTATION: A 44-year-old man presented with the complaint of neck pain. The results of his physical and neurological examinations were within normal ranges, except for pain exacerbated by neck motion and spasm of the cervical musculature. Magnetic resonance imaging demonstrated a cystic lesion involving the odontoid process and body of C1 and C2, with thin and regular cyst walls and cyst contents similar in intensity to that of cerebrospinal fluid. The results of serological tests performed with the suspected diagnosis of hydatid disease were positive. INTERVENTION: The patient initially underwent surgery to provide stabilization of the craniocervical junction, using autogenous bone graft and sublaminar wiring from the occiput to C3 via a posterior approach. The cyst was approached via a transoral route, using a U-shaped pharyngeal incision. There were no neurological deficits after surgery. Postoperative magnetic resonance imaging scans confirmed complete excision of the cyst, and the patient was discharged on the 12th postoperative day. He received six cycles of albendazole treatment, each consisting of 28 days with an intervening drug-free period of 2 weeks. Magnetic resonance imaging scans performed 1 year after surgery revealed the patient was still disease-free. CONCLUSION: Hydatid disease should be considered in the differential diagnosis of spinal cord compression, especially in endemic areas. Although the chance of obtaining a cure is unlikely, radical surgery coupled with antihelminthic therapy seems to provide long-lasting relief.
PubMed, 2010
Aim: Knowing the location of the transverse sinus in the midline supracerebellar infratentorial a... more Aim: Knowing the location of the transverse sinus in the midline supracerebellar infratentorial approach is important to prevent its inadvertent injury. The external landmarks of the occipital bone have been studied in this anatomic study in order to reveal their relationship with the transverse sinus. Material and methods: Fifty-two dried skulls were used to study the relationship of the transverse sinus with various surface bone structures. The key bone surface structures identified in each specimen were the superior nuchal line, the inferior nuchal line, the inion, internal occipital protuberance, and the transverse sulcus. Results: The distance from the inion to the inferior nuchal line in specimens ranged from 12.7 mm to 37.7 mm. The distance from the inferior nuchal line to the midline foramen magnum in the specimens ranged from 19 mm to 34.75 mm. The width of the proximal transverse sulcus ranged from 2.6 mm to 10.16 mm with an average of 6.43 mm on the right side and 3.4 mm to 10.6 mm with an average of 6.15 mm on the left. Conclusion: The first and most superior burr hole for midline supracerebellar infratentorial approach can be safely placed approximately 1 cm below the inferior nuchal line. A burr hole in this localization will avoid the transverse sinus.
PubMed, Apr 1, 2009
Primary spinal hydatid disease is rare. Spinal hydatid disease should be considered in the differ... more Primary spinal hydatid disease is rare. Spinal hydatid disease should be considered in the differential diagnosis of spinal cord compression syndrome in endemic countries and evaluated with imaging and serology. Our case was a 34- year-old man. The patient presented with progressive back pain for 8 months and lower extremity weakness for 3 months. Neurological examination was suggestive of upper motor neuron type of paraperesis. Magnetic resonance images of the thoracal region showed an intradural multicystic lesion. The mass was explored with T 10-11 laminectomy. It had displaced the cord to the right side. The fluid was clear and did not contain pus. The lesion was easily dissected from the cord and was resected totally. The pathological diagnosis was hydatid disease.
PubMed, 2007
Extensive and aggressive surgical removal is treatment of choice for patients who have chordomas ... more Extensive and aggressive surgical removal is treatment of choice for patients who have chordomas of the cranial base. Well-developed microsurgical techniques, as well as good surgical judgment learned from experience are essential to avoid major morbidity. A 14-year-old female presented with progressive headaches and diplopia for three months. Cranial magnetic resonance imaging demonstrated a well-circumscribed mass in the clival region. The mass was totally excised via right combined pterional transsylvian and anterior temporal approach (+ orbitozygomatic osteotomy). The tumor was located extradurally. The resected tumor had the typical histological and immunohistochemical characteristics of chordoma. No radiation therapy or chemotherapy was administered.
PubMed, 2008
Cranial bone and epidural tuberculosis is rare manifestation extrapulmonary tuberculosis. The inc... more Cranial bone and epidural tuberculosis is rare manifestation extrapulmonary tuberculosis. The incidence of tuberculosis of calvaria is on the rise in developing countries because of malnutrition, poor socioeconomic conditions, and immunodeficiency. We present the clinical features, radiology, histopathology, and surgical findings of a case of tuberculosis of the frontal bone with epidural extension. A 46 year-old female had presented with a history of painless right frontal swelling for the previous 4 months. The patient was operated on at a peripheral center for swelling in the right frontal region. In postoperative period, a leak that did not reply to nonspecific antibiotic therapy developed on the lesion. Right frontal epidural effusion was found in the patient who presented our clinic. Histopathological and microbiological examination suggested a diagnosis of tuberculosis.
PubMed, Apr 1, 2009
An aneurysmal bone cyst (ABC) typically involves the long bones of the extremities, thorax, pelvi... more An aneurysmal bone cyst (ABC) typically involves the long bones of the extremities, thorax, pelvis, or vertebrae. Skull base involvement is rare. We describe the case of a 9-year-old girl with ABC of the skull base. The patient had presented with nasal obstruction and headache over a period of approximately 8 months. The patient had no history of trauma or surgery. Physical and neurological examination findings normal. Magnetic resonance imaging (MRI) showed a multicystic lesion arising from the sphenoid sinus and extending into ethmoid sinus, superior nasal cavity and medial walls of the orbit. The lesion contained thin internal septations that revealed high signal characteristics on all sequences. The lesion was resected via an extended frontal approach without any complications. Histological evaluation confirmed that the lesion was an ABC. The patient did not receive postoperative radiotherapy. No recurrence was observed after 22 months. ABC should be considered in the differential diagnosis of bone neoplasms in this region.
Turkish Neurosurgery, 2009
The primary brain tumors associated with cerebral aneurysms are rare in neurosurgical practice. T... more The primary brain tumors associated with cerebral aneurysms are rare in neurosurgical practice. The present article constitutes an evaluation of the management of coexistent primary brain tumor and cerebral aneurysm. A retrospective study of three cases of primary brain tumor with cerebral aneurysm was performed. We evaluated the complications and clinic outcomes by assessing the clinical and imaging findings. Case 1 presented with a subarachnoid hemorrhage from an aneurysm of the anterior communicating artery, with an incidental left frontal oligodendroglioma. Case 2 presented with chronic headache due to left frontal convexity meningioma, with proximal internal carotid artery aneurysm which was found incidentally during preoperative magnetic resonance angiography. Case 3 was admitted to our hospital complaining of headache, memory disturbance, and weakness in her left lower extremity. Magnetic resonance imaging revealed right frontal lymphoma and an unruptured aneurysm at the left middle cerebral artery. Preoperative magnetic resonance imaging revealed right frontal lymphoma and unruptured left middle cerebral artery. The frequency of primary brain tumor and cerebral aneurysm coexistence is increasing due to improvements in high-resolution imaging. In these complicated cases, the management will differ according to each pathology present, and this is an important problem for a neurosurgeon.
Turkish Neurosurgery, 2010
Tuberculosis has been an important public health problem in both developing and develop nations. ... more Tuberculosis has been an important public health problem in both developing and develop nations. Tuberculosis of the central nervous system is rare. Tuberculosis meningitis and tuberculoma are the two most important manifestations of tuberculosis of the CNS. Intracranial tuberculomas may be solitary or multiple. Solitary tuberculomas may be indistinguishable from cranial abscess or primary brain tumor. It is necessary to rule out tuberculoma in patients with intracranial mass lesions. We present a case of tuberculoma mimicking a high grade glial tumor on magnetic resonance imaging and clinical presentation. A 30-year-old woman presented with one-month history of epilepsy. Cranial magnetic resonance imaging showed a left occipital peripheral ring-enhanced lesion with central necrosis. There was a strong suspicion of glial tumor. The lesion was totally excised with left occipital craniotomy. Histological examination of mass revealed a tuberculoma. The patient was treated with antituberculous chemotherapy.
Turkish journal of trauma & emergency surgery, Jul 1, 2005
Ateşli silahla başlarından yaralanmaları nedeniyle hastanemizde tedavisi yapılan sivil hastalarda... more Ateşli silahla başlarından yaralanmaları nedeniyle hastanemizde tedavisi yapılan sivil hastalarda tedavi şekilleri dikkate alınmaksızın 7 günlük sağkalımı etkileyen faktörler istatistiksel olarak incelenerek GKS, pupilla defekti, koagülopati, intraventriküler penetrasyon, tutulan hemisfer sayısı gibi faktörlerin prognoz üzerine etkileri ortaya konmaya çalışıldı. GEREÇ VE YÖNTEM Hastalar tedavi şekilleri dikkate alınmaksızın yaralanmayı izleyen 7 gün içinde toplam mortaliteleri yönünden iki gruba ayrıldı. Başlangıç Glasgow Koma Skoru (GKS), pupillanın ışık cevabı, koagülopati, ventriküler penetrasyon ve tutulan hemisfer sayısından oluşan toplam 5 değişkenin ayrı ayrı ve birlikte 7 günlük mortalite üzerine olan etkileri ve istatistiksel anlamlılıkları araştırıldı. BULGULAR Çalışma grubundaki 48 hastanın 36' sı (%75'i) erkek, 12' si (%25'i) kadındı. Çalışma grubumuzda toplam sağkalım oranı %27 (13/48), 7 günlük sağkalım oranı % 31 (15/48) olarak saptanmıştır. GKS, pupilla defekti, koagülopati, intraventriküler penetrasyon, tutulan hemisfer sayısını içeren değişkenlerden 7 günden kısa sağkalımı olanlarda mortalite üzerine en yüksek etkinin öncelikle koagülopati daha sonra da pupilla defekti ile olduğu saptanmıştır. Diğer değişkenler mortalite üzerine anlamlı ölçüde etkili olmayıp sonuçlar literatürle paralellik göstermiştir. SONUÇ Ateşli silahlarla başlarından yaralanmış hastalarda pupilla defekti ve koagülopati prognoz tahmininde istatistiksel olarak anlamlı bulunmuştur. Nörolojik durumu kötü bile olsa bu tür hastalarda agresif medikal ve cerrahi tedavinin faydalı olacağı düşüncesindeyiz. Anahtar sözcükler: koagülopati, pupilla defekti, prognoz, sivil kranyal ateşli silah yaralanması. BACKGROUND Patients with civil cranial gunshot injuries who were treated in our hospital were statistically analized for the factors acting on 7 days survival and prognosis without regarding treatment modalities. MATERIAL AND METHOD Patients were divided into two groups according to the mortality rates in 7 days following the trauma without regarding treatment modalities. Initial GCS score, pupillary response to light, coagulopathy, ventricular penetration and number of hemispheres affected are 5 differentials evaluated separately and in combination for their effects on mortality rates within 7 days posttraumatically and their statistical significance. RESULTS Thirty six male (75%) and 12 female (25%) patients included in the study. Total and 7 day-survival rates were 27% (13/48), and 31% (15/48) respectively. Among GCS scores, pupillary defects, coagulopathy, intraventricular penetration, the number of hemispheres affected, the most important prognostic factors of the patients living less than 7 days were found to be primarily coagulopathy and then pupillary defects. The other variables were not significantly effective and the results were in accordance with the literature. CONCLUSION In civilian patients with cranial gunshot injuries pupillary defect and coagulopathy were statistically significant prognostic factors. We think that agressive medical and surgical treatment will be beneficial even if the patients' neurological status is deteriorating.
Rivista Di Neuroradiologia, Nov 27, 2019
Medulloblastoma (MB) that arises outside the cerebellum from cells of the dorsal brainstem is rar... more Medulloblastoma (MB) that arises outside the cerebellum from cells of the dorsal brainstem is rare. The most common subtype of MB in the dorsal brainstem is the Wingless (WNT) subtype that contains activating mutations in the WNT pathway effector CTNNB1. Ipsilateral cerebellar hemi-atrophy with a brainstem tumour is a finding that is usually documented with brainstem gangliogliomas as a possible specific imaging sign. We present a case of a 23-year-old female with progressive headache, imbalance on walking, double vision and difficulty in swallowing for a year. Magnetic resonance imaging demonstrated a mass with prominent restricted diffusion on the dorsal surface of the lower brainstem with ipsilateral cerebellar atrophy. The final histopathological diagnosis was a Sonic Hedgehog (SHH)-activated and TP53 wild-type primary lower dorsal brainstem MB. Primary SHH-activated TP53 wild-type dorsal brainstem MB is extremely rare, and as far as we know, the association of the tumour with ipsilateral cerebellar hemi-atrophy in an adult has never been reported. MB should be included in the differential diagnosis of focal dorsal brainstem tumours, even in the presence of ipsilateral cerebellar hemi-atrophy.
Neurology India, 2010
Lhermitte-Duclos disease (LDD) is a pathologic entity with progrediating, diffuse hypertrophy chi... more Lhermitte-Duclos disease (LDD) is a pathologic entity with progrediating, diffuse hypertrophy chiefly of the stratum granulosum of the cerebellum. Typically LDD is a unilateral lesion of the cerebellum or in vermis. Here we report a case of LDD with bilateral lesions of cerebellar hemispheres managed surgically. A 28-year-old woman presented with one-year history of progressive headache, nausea, vomiting, and blurred vision. Neurologic examination revealed a bilateral mild papilledema, mild dysmetria, and dysdiadochokinesia. The cerebellar lesions caused moderate mass effect in posterior fossa with hydrocephalus, and Chiari type I malformation. We performed the suboccipital-retrosigmoid approach, and removed completely the left intracerebellar mass. Symptoms related to elevated intracranial pressure disappeared in a short period postoperatively.
Neurosurgical Review, Apr 5, 1999
The posterior fossa is an uncommon site for epidural hematomas. Clinical progress is silent and s... more The posterior fossa is an uncommon site for epidural hematomas. Clinical progress is silent and slow, but the deterioration is sudden and quick to become fatal if not promptly treated. Early recognition is therefore extremely important. The recommended treatment for posterior fossa epidural hematoma is surgical evacuation soon after the diagnosis, since the posterior fossa contains vital structures. However, conservative management under close clinical and radiological supervision can be applied in patients without mass effect. In our study, a review of 73 cases with posterior fossa epidural hematoma among a total number of 737 patients with epidural hematoma is presented, and a new neuroradiological classification is proposed in order to determine the appropriate type of treatment. In this series, 14 patients were treated conservatively, while 59 required surgery. The conservatively treated 9 pediatric and 5 adult patients, and 51 of the 59 surgically treated cases, in other words a total of 65 of the 73 patients, showed excellent recovery; 4 patients treated surgically had a moderate disability, and 4 patients died (overall mortality 5.4%). The critical factors influencing outcome were the neuroradiological class, the level of consciousness just before the operation, and the other systemic and/or intracranial traumatic lesions. In this study, the critical observation was that the neuroradiological findings were earlier, more reliable and predictive than the clinical findings. Therefore, based upon the obliteration of perimesencephalic cisterns and/or displacement of the fourth ventricle, a new neuroradiological classification was designed for decision-making in management.
Sinir sistemi cerrahisi dergisi, May 2, 2014
Surgical treatment of posterior circulation aneurysms is more difficult than surgical treatment o... more Surgical treatment of posterior circulation aneurysms is more difficult than surgical treatment of anterior circulation aneurysms and poses a greater technical challenge for the practicing neurosurgeon. There are different surgical options available for the surgical treatment of posterior circulation aneurysms despite the use of the pterional approach to anterior circulation aneurysms. We present our surgical experiences with three cases of posterior circulation aneurysms. Three cases of posterior circulation aneurysms were treated by surgical clipping. We preferred pterional approach for posterior cerebral artery aneurysms, infratentorial supracerebellar approach for superior cerebellar aneurysm, and the combined lateral supracerebellar infratentorial retrosigmoid approach for vertebrobasilar junction aneurysm. The morbidity and mortality associated with open surgery for posterior circulation aneurysms are higher because of the location of the aneurysms within the posterior fossa. For neurosurgeons, the surgical treatment of posterior circulation aneurysms can be challenging.
European Journal of Radiology, Nov 1, 2011
Meningiomas are generally benign masses, and in many cases they do not invade the brain. Therefor... more Meningiomas are generally benign masses, and in many cases they do not invade the brain. Therefore their potential to provide cures is high. The most important cause of the development of recurrence in the post-operative period is subtotal resection. Any information that will allow us to perform total mass resection will be beneficial in terms of long-term good clinical procedure. Our aim in this study is to obtain the radiological data from which we can obtain accurate information in terms of the surgical cleavage between the tumor and parenchyma during the surgical planning of the meningiomas. We evaluated 85 cases with intracranial meningioma that were treated by the same microsurgical technique. All posterior fossa and skull base meningiomas were not included in the study. Tumor size was smaller than 3 cm in 19 cases, between 3 and 6 cm in 46 cases, and bigger than 6 cm in 20 cases. The cleavage line between the tumor capsule and the cortex underneath was extrapial in 32 cases, subpial in 29 cases, and mixed in 24 cases. Dominant arterial supply was dural in 46 cases. Thirty-three cases were predominantly mixed and 6 cases were predominantly corticopial. At magnetic resonance images, 16 of 28 cases which showed clear tumor-cortex interface, had an extrapial cleavage line. When surgical treatment of intracranial meningiomas are considered, it is necessary to examine if there is a surgically safe border between the cortex underneath in the preoperative images. It can be concluded that it is appropriate to operate small meningiomas which are on the sensitive regions of the brain when they are in their earlier stages and still have an extrapial cleavage.
VI. Mantık Çalıştayı Kitabı, Dec 30, 2016
VI. Mantık Çalıştayı Kitabı, Ed: Vedat Kamer, Şafak Ural, Mantık Derneği Yayınları, İstanbul, Ara... more VI. Mantık Çalıştayı Kitabı, Ed: Vedat Kamer, Şafak Ural, Mantık Derneği Yayınları, İstanbul, Aralık 2016, ss. 528.
ISBN: 978-605-66311-1-5
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