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    Clinical results of anterior odontoid screw fixation for type II odontoid fractures
    (Turkish Neurosurgical Society, 2014) Keskin, Fatih; Gomleksiz, Cengiz; Sasani, Mehdi; Oktenoglu, Tunc; Suzer, Tuncer; Özer, Ali Fahir; Faculty Member; School of Medicine; 1022
    AIM: In this study, 31 patients with a diagnosis of Type II odontoid fractures were reported. All patients were treated with anterior transodontoid screw fixation and clinical outcomes were reported. MATERIAL and METHODS: In this study, the retrospective clinical analysis of 31 patients with traumatic type II odontoid fractures who were treated through anterior transodontoid fixation in Neurosurgery Department at VKV American Hospital between 1998 and 2012 was performed. The age, sex, cause of injury, diagnosis time, neurological examination before and after surgery, follow-up period were evaluated. The neurological status of patients was classified according to the Frankel scale. RESULTS: In 4 patients, 2 transodontoid screws were inserted. The mean hospital stay was 3.35 days. Posterior occipito-cervical fusion was done in 1 patient due to the lack of fusion in the first operation. No vascular injury, screw malposition, infection, neurologic deterioration, or complications were observed during the peroperative and postoperative stage. The mean postoperative follow-up period was 36 months after surgery. Radiological imaging of patients were performed at the early and late postoperative stage. CONCLUSION: We found satisfying fusion rates and better patient comfort during the postoperative period. We think that stabilization and fusion through a transodontoid screw is a minimal invasive method.AMAÇ: Çalışmada, Tip II odontoid fraktürü tanısı alan 31 olgu bildirilmiştir. Olguların hepsi anterior transodontoid vida fiksasyonu ile tedavi edilmiş ve klinik sonuçları bildirilmiştir. YÖNTEM ve GEREÇLER: Çalışma, VKV Amerikan Hastanesi Nöroşirürji Bölümü’nde 1998-2012 yılları arasında travmatik tip II odontoid kırığı nedeniyle anterior transodontoid fiksasyon ile cerrahi tedavi uygulanan 31 hastanın retrospektif klinik analizleri yapılmıştır. Tüm olguların yaş, cinsiyet, travma nedeni, teşhis zamanı, cerrahi girişim öncesi ve sonrasında nörolojik muayeneleri, takip süresi değerlendirilmiştir. Olguların nörolojik durumları Frankel skalasına göre sınıflandırılmıştır. BULGULAR: Dört hastaya 2 adet transodontoid vidası yerleştirildi. Hastanede kalış süresi ortalama 3,35 gün idi. 1 hastada postop takibinde füzyon oluşmaması nedeniyle ikinci bir operasyon ile posteriordan oksipitoservikal füzyon yapıldı. İşlem sırasında ve sonrasında damar yaralanması, vida malpozisyonu, enfeksiyon, nörolojik bozulma gibi komplikasyonlar izlenmedi. Hastalar ameliyat sonrasında ortalama 36 ay takip edildi. Hastaların erken ve geç dönemde radyolojik görüntülemeleri yapıldı. SONUÇ: Postoperatif dönemde hastaların takiplerinde tatmin edici füzyon oranı ve hasta konforunun daha iyi olduğunu saptadık. Tip II odontoid kırıklarının cerrahi tedavisinde minimal invaziv yöntem olan transodontoid vida ile fiksasyonun yüksek avantajlarından dolayı ilk seçenek olabileceğini düşünüyoruz.
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    Dynamic stabilization of the lumbar spine using the Dynesys® system
    (Turkish Neurosurgical Soc, 2020) Cevik, Orhun Mete; Akyoldaş, Göktuğ; Süzer, Süleyman Tuncer; Sasani, Mehdi; Öktenoğlu, Bekir Tunç; Özer, Ali Fahir; Faculty Member; Faculty Member; Faculty Member; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; 203677; 221691; 219451; 220898; 1022
    AIM: To present the clinical results in patients with minor instability with "Dynesys (R)"a soft spinal stabilization system. Material and Methods: A total of 83 patients were operated upon and the Dynesys (R) system was applied. Indications for surgery included painful degenerative disc disease, degenerative spondylolisthesis and lumbar canal stenosis. Results: The results for the Dynesys (R) system were satisfactory, and we have calculated the overall complication rate to be 20.4% (n=17), which is in agreement with the literature. Conclusion: The Dynesys (R) dynamic stabilization system effectively protects lumbar motion and achieves lumbar stability in patients with lumbar spinal problems. Our clinical result support literature that Dynesys (R) system is a strong alternative to fusion and instrumentation system in patient with chronic instabilities.
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    Gamma knife radiosurgery for hemorrhagic brainstem cavernomas
    (Turkish Neurosurgical Soc, 2019) Üçüncü Kefeli, Ayşegül; Şengöz, Meriç; N/A; Peker, Selçuk; Faculty Member; School of Medicine; Koc University Hospital; 11480
    AIM: To assess treatment results of gamma knife radiosurgery (GKRS) for hemorrhagic brainstem cavernous malformations (BSCMs). MATERIAL and METHODS: A retrospective review of patients with hemorrhagic BSCMs, who were treated at the Acibadem Kozyatagi Hospital GKRS unit from May 2007 to October 2015 was performed. RESULTS: In total, 82 patients were identified. All patients had experienced at least one hemorrhagic event (range 1-3), and all of them presented with radiological evidence of hemorrhage. The median target volume was 0.3 ml, and the median marginal radiation dose was 12 Gy. The mean durations before and after surgery were 25.5 (range 1-204) months, and 50.3 (range 13-113) months, respectively. Pre-treatment hemorrhage rates were calculated from the date of first hemorrhage to the date of radiosurgery. There were 97 bleeds over 174.4 patient-years during the observation period, with an annual hemorrhage rate of 55.7%. If the first bleed is excluded, the annual hemorrhage rate was 8.6%. Only three patients demonstrated re-bleeding, which occurred at 3, 12 and 79 months after radiosurgery. Over a total follow up time of 344 patient-years the annual re-bleeding rate was therefore 0.87%, indicating that the risk of BSCM hemorrhage was significantly decreased by radiosurgery. CONCLUSION: GKRS was a safe and effective treatment for symptomatic low volume BSCMs when a low marginal dose is used. A randomized controlled trial is needed that compares GKRS to observation if we want to establish the true efficacy of this treatment.
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    Complications of 2-level dynamic stabilization: a correlative clinical and radiological analysis at two-year follow-up on 103 patients
    (2018) Yılmaz, Atilla; Erbulut, Deniz Ufuk; N/A; Çıplak, Necati Mert; Süzer, Süleyman Tuncer; Şentürk, Salim; Yaman, Onur; Sasani, Mehdi; Öktenoğlu, Bekir Tunç; Özer, Ali Fahir; Doctor; Doctor; Doctor; Doctor; Faculty Member; Faculty Member; Faculty Member; N/A; N/A; N/A; N/A; School of Medicine; School of Medicine; School of Medicine; Koc University Hospital; N/A; 221691; N/A; 219524; 219451; 220898; 1022
    AIM: To investigate the postoperative complications, such as screw loosening, screw breakage and adjacent segment disease (ASD), in patients who underwent surgery with 2-level dynamic stabilization systems. MATERIAL and METHODS: Postoperative complications, clinical improvements and radiological parameters in patients who underwent surgery using a dynamic system for 2-level lumbar stabilization were retrospectively reviewed. A total of 103 patients with lumbar degenerative spinal instability underwent 2-level dynamic stabilization. Clinical findings were reviewed at 2-year follow-up. Screw breakage and loosening were evaluated during this duration together with clinical findings. ESULTS: Visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were significantly decreased at the four-month evaluation, and they were also decreased at the 1-year follow up and at the 24th postoperative month. ASD was diagnosed in twelve (8 females, 4 males) of the 103 patients in the follow-up radiological and clinical controls. There were 9 screw breakages and 4 screw loosening cases. The complication rate of 2-level dynamic stabilization was high in this study. CONCLUSION: Our results showed that complications (screw loosening or breakage and adjacent segment disease) are not rare after 2-level dynamic stabilization, unlike the acceptable results with the single-level dynamic system. The most probable explanation is that the instrument system behaves more rigidly with every additional segment.
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    Posterior dynamic stabilization for the treatment of patients with lumbar degenerative disc disease: long-term clinical and radiological results
    (Turkish Neurosurgical Soc, 2013) Canbay, Suat; Aydin, Ahmet Levent; Aktas, Elif; Erten, Serhat Fuat; Basmaci, Mehmet; Sasani, Mehdi; Özer, Ali Fahir; Faculty Member; School of Medicine; 1022
    AIM: Comparison of long-term preoperative and postoperative clinical and radiological results for patients diagnosed with degenerative disc disease that underwent posterior dynamic stabilization. Lumbar disc degeneration is caused by a variety of factors. Disruptions in the vertebral endplate result in defects in disc nutrition and, thus, disc degeneration. The aims of dynamic stabilization are to unload the disc/facet joints, preserve motion under mechanical load, and restrict abnormal motion in the spinal segment. MATERIAL and METHODS:Twenty-five patients diagnosed with lumbar degenerative disc disease were enrolled.Totally, 25 vertebral segments were subjected to posterior dynamic stabilization. Patients were clinically evaluated in the preoperative and postoperative periods using the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS). Segmental movement was evaluated radiologically in the late postoperative period by measuring the segmental angles during flexion and extension. RESULTS: Significant postoperative improvements were observed in the ODI and VAS measurements (P<0.01). During the long postoperative period (averaging 5 years and 2 months), lumbar lordosis angles, intervertebral space ratio and segmental ratio were measured and compared statistically. Adjacent segment disease developed in two patients. Both patients received L5-S1 discectomy. CONCLUSION: Good clinical outcomes were observed in the treatment of lumbar degenerative disc disease with a posterior dynamic system. / AMAÇ: Dejeneratif disk hastalığı tanısı almış ve posterior dinamik stabilizasyon sistemi uygulanmış hastaların uzun dönem preoperatif ve postoperatif klinik ve radyolojik sonuçlarının karşılaştırılması. Lomber dejeneratif disk hastalığına birçok etken sebep olur. Bu etkenler sonuç olarak omurga son plaklarında dejenerasyona ve disk dokusunun beslenmesinin bozulmasına yol açar. Dinamik stabilizasyon sistemleri, omurlar arasındaki hareketi korurken, disk ve faset eklemleri üzerindeki aşırı yüklenmeyi azaltır, aynı zamanda da omurga segmentindeki anormal hareketlenmeyi önler. YÖNTEM ve GEREÇLER: Bu çalışmada, dejeneratif disk hastalığı tanısı konmuş 25 hasta ele alınmıştır. Toplamda 25 omurga segmentine posterior dinamik stabilizasyon uygulanmıştır. Hastalar, preoperatif ve postoperatif dönemde Oswestry Disability Index (ODI) and Vizüel Analog Skala (VAS) ile klinik olarak değerlendirilmiştir. Segmental hareketi değerlendirmek için geç postoperatif dönemde radyolojik olarak fleksiyon ve ekstansiyon grafileri kullanılmıştır. BULGULAR: Postoperatif dönemde ODI ve VAS ölçümlerinde anlamlı düzelmeler kaydedilmiştir (P<0,01). Ameliyatlardan sonraki uzun dönem takiplerinde (ortalama 5 yıl 2 ay), lomber lordoz açısı, intervertebral aralık oranı ve segmental oran ölçülmüş ve istatiksel olarak değerlendirilmiştir. İki hastada postoperatif dönemde komşu segment hastalığı tespit edilmiş ve bu hastalarda L5-S1 diskektomi uygulanmıştır. SONUÇ: Lomber dejeneratif disk hastalığının cerrahi tedavisinde posterior dinamik stabilizasyon sistemi başarılı sonuçlar vermektedir.
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    Effects of resveratrol on inflammation and apoptosis after experimental spinal cord injury
    (Buluş Design, 2018) Yaman, Mesut Emre; Aydın, Hasan Emre; Güney, Güven; Bozkurt, Ismail; Paksoy, Kemal; Abdioğlu, Ahmet Atilla; N/A; Şentürk, Salim; Doctor; N/A; Koç University Hospital; N/A
    Aim: To determine the effects of resveratrol on inflammation and apoptosis after experimental spinal cord injury (SCI). Material and Methods: Eighteen Sprague-Dawley rats were randomly divided into three groups. All groups underwent thoracic laminectomy. The first group received no other intervention. The second and third groups suffered SCI via the aneurysm clip compression method, and additionally the third group received resveratrol. After euthanizing the rats, immunohistochemical analysis and biochemical parameters of tumor necrosis factor alpha (TNF-alpha) and interleukin (IL)-1 beta were measured. Results: The resveratrol group had statistically significant lower levels of TNF-alpha, IL -1 beta, and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) positive cells and higher number of glial and motor neuron cells. Conclusion: Resveratrol proves to have remarkable neuroprotective effects on SCI in an experimental model in addition to its proven cardioprotective effects.
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    POLY 382-New directions in silicone-urea copolymers
    (Turkish Neurosurgical Soc, 2019) Öğrenci, Ahmet; Koban, Orkun; Yılmaz, Mesut; Yaman, Onur; Dalbayrak, Sedat; N/A; Yaman, Onur; Doctor; N/A; Koç University Hospital; 219524
    Aim: To evaluate the satisfaction of patients operated due to degenerative lumbar spinal diseases with dynamic stabilization placing polyetheretherketone (PEEK) rods and to share their radiological and clinical results (mid-term) with visual analogue scale (VAS) and Oswestry disability index (ODI) scores. Material and Methods: The preoperative and postoperative low back pain, leg pain VAS and ODI scores of 172 patients who were operated for degenerative spinal diseases, were evaluated. Preoperative and postoperative lumbar lordosis were compared. The patients included to the study were evaluated postoperatively around the 2nd year with lumbar MRI by means of adjacent segment disease (ASD) and additional problems. Results: A statistically but not radiologically-by means of sagittal profile reconstruction-significant increase in lumbar lordosis angle was achieved. Significant improvement was observed in the comparison of preoperative and postoperative period in the analysis of patients' preoperative low back pain (p<0.0001), and decompression-related leg pain VAS scores (p<0.0001). Significant improvement was also observed in the ODI scores of the patients (p<0.0001). Among 172 patients with dynamic stabilization, there were 10 patients who underwent reoperation (5.8%). Conclusion: Although it is statistically significant, it can be seen that the lumbar lordosis can not be corrected at significant degrees radiographically in the operations performed with the PEEK rod. Dynamic stabilization with PEEK rod is insufficient for sagittal correction, but the mid-term results reached satisfactory reoperation rates clinically outcomes. Rate of ASD is quite low in stabilization with PEEK rod.
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    Tlr4 asp299gly and thr399ile and tlr2 intron 2 microsatellite gene polymorphism in patients with acute biliary pancreatitis: does it cause the disease?
    (Aves, 2018) Anılır, Ender; Özen, Filiz; Özemir, İbrahim Ali; Yıldırım, İbrahim Halil; Bilgiç, Çağrı; N/A; Other; N/A; N/A
    Objectives: There has been coverage of Toll-like receptor 4 and Toll-like receptor 2 gene polymorphisms in inflammatory episodes in a number of studies. In view of the inflammatory nature of acute pancreatitis, we aimed to determine the predictive value of mutations in Asp299Gly and Thr399Ile of the Toll-like receptor 4 gene, and the intron 2 microsatellite polymorphism of the Toll-like receptor 2 gene on the occurrence of acute biliary pancreatitis. Material and Methods: The study included 86 patients for the Toll-like receptor 4 Thr399Ile polymorphism, 100 patients for the Toll-like receptor 4 Asp299Gly polymorphism with acute biliary pancreatitis, and 101 healthy volunteers. At the same time, 93 patients and 92 healthy volunteers were included in the study to research the Toll-like receptor 2 intron 2 microsatellite polymorphism. Genotypes were determined using the restriction fragment length polymorphism analysis of PCR products and by an allele-specific PCR. Results: The Toll-like receptor 4 Thr399Ile homozygotes mutant variants (p=0.005) and Toll-like receptor 2 MM genotype (p<0.001) were detected with a significantly higher frequency in patients with acute biliary pancreatitis than in the healthy blood donors. Conclusion: The Toll-like receptor 4 Asp299Gly and Thr399Ile polymorphisms and the Toll-like receptor 2 intron 2 microsatellite polymorphism are statistically associated with ABP.
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    Comparative biochemical and motor function analysis of alpha lipoic acid and N-acetyl cysteine treatment on rats with experimental spinal cord injury
    (2016) Gürçay, Ahmet Gürhan; Gürcan, Oktay; Kazancı, Atilla; Bozkurt, İsmail; Bodur, Ebru; Türkoğlu, Ömer Faruk; Bavbek, Murad; N/A; Şentürk, Salim; Doctor; N/A; Koc University Hospital; N/A
    Aim: Spinal Cord Injury (SCI) is a devastating health problem both for the patient and the clinician. Numerous treatment modalities have been studied to reverse the effects of spinal cord injury. Herein is reported the effects and the comparison of Alpha Lipoic Acid and N-Acetyl Cysteine on rats with SCI. Material and Methods: 38 adult male Sprague-Dawley rats were randomly divided into 5 groups: only laminectomy, laminectomy and trauma, laminectomy trauma and Alpha Lipoic Acid 100 mg/kg IP administration, laminectomy trauma and N-Acetyl Cysteine 300 mg/kg IP administration, and vehicle group (PEG). The trauma model was the Modified Allen Weight drop method. After the procedure, the rats’ motor function was evaluated using the modified Tarlov Scale and consequently they were sacrificed and the spinal cord tissue was analyzed biochemically for inflammation markers. Results: Both Alpha Lipoic Acid and N-Acetyl Cysteine administration after the injury significantly improved the results. There was no statistically significant difference in between the agents. Conclusion: Although these agents both proven to be effective in ameliorating the effects of SCI, there was not enough evidence in this research to conclude the benefit of one agent over the other.
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    Assessment of the MRI and behavioral test results in a focal cerebral ischemia-reperfusion model in the rat after separate and combined use of mouse-derived neural progenitor cells, human-derived neural progenitor cells and atorvastatin
    (Turkish Neurosurgical Soc, 2018) Tanta, Alican; Izgi, Nail; Erdag, Ece; Aras, Yavuz; Genc, Cetin; N/A; Önder, Tuğba Bağcı; Faculty Member; School of Medicine; 184359
    AIM: To assess the efficacy of Neural progenitor cell (NPC) transplantation in ischemic stroke, and to investigate whether atorvastatin enhances therapeutic potency of NPC after stroke. MATERIAL and METHODS: The focal cerebral ischemia-reperfusion model was performed by transient occlusion of middle cerebral artery. Rats were assigned randomly to receive intracerebral transplantation of mouse NPC alone (mNPC), human NPC alone (hNPC), mouse NPC plus oral atorvastatin (mNPC+A), human NPC plus oral atorvastatin (hNPC+A), oral atorvastatin alone, or intracerebral Dulbecco's Modified Eagle's medium injection (control group). Adhesive removal, rotarod, cylinder tests, and magnetic resonance imaging (MRI) were used for assessment of rats during 4 weeks. After sacrification on 28th day, rats were investigated by immunofluorescent staining. RESULTS: The hNPC and mNPC groups showed significantly improved functional outcome and reduced infarct area ratio compared with the control group. The hNPC group had significantly better performance and lower infarct area ratio than the mNPC group. Addition of atorvastatin to stem cell therapy significantly improved functional outcome, although it did not affect the infarct area ratio on MRI. Anti-inflammatory response in the infarct area was higher in the mNPC group. NPC transplantation significantly reduced the amount of microglia and a significant increase in the amount of astrocytes. CD8a+ T lymphocyte and granzyme B activities were not detected in any of the subjects. CONCLUSION: Both hNPC and mNPC treatments significantly improved functional outcome, and reduced infarct area ratio after stroke. Atorvastatin enhanced the therapeutic potency of NPCs, including neurological improvement.