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Permanent URI for this collectionhttps://hdl.handle.net/20.500.14288/3
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Publication Metadata only Percutaneous endoscopic translaminar approach in a patient with pedicle screw malposition and cement leakage(Taylor and Francis Ltd., 2023) Şentürk, Salim; Ünsal, Ülkün Ünlü; Koç University HospitalWe present a 79-year-old female patient who had L2–5 dynamic stabilization with cement (Polymethylmethacrylate) injection 6 weeks prior. Due to post-operative right radicular pain, a lumbar CT was scheduled in which a malposition of the right L4 screw and cement leakage was observed. Via a percutaneous translaminar endoscopic approach the leaked cement was removed and the portion of the screw in contact with the nerve root was drilled. With this minimal-invasive procedure, the patient was relieved of her radicular pain.Publication Metadata only Can TRIF/TICAM-1 dependent pathway be target pathway in lumbar intervertebral disc degeneration?(Turkish Neurosurgical Society, 2023) ALIZADA, Orkhan; AKYOL, Sibel; OZLEN, Fatma; CETINTAS, Semih Can; TURK, Okan; HANCI, Murat; N/A; Akgün, Mehmet Yiğit; N/A; Koç University HospitalAIM: To elucidate the role of the TIR-domain-containing adaptor-inducing interferon-β (TRIF) dependent pathway in intervertebral disc degeneration (IVD). MATERIAL and METHODS: A total of adult male patients with low back pain (LBP) (+/- radicular pain) were further evaluated by magnetic resonance imaging (MRI) with surgical indication for microscopic lumbar disc herniation (LDH). Preoperatively, patients were classified according to Modic Changes (MC), nonsteroidal anti-inflammatory drugs (NSAIDs) use, and the presence of radicular pain in addition to the LBP. RESULTS: The age of the 88 patients ranged from 19 to 75 years (mean: 47.3 ± 19.6 years). Twenty eight of the patients were evaluated as MC I (31.8%), 40 as MC II (45.4%), and 20 as MC III (22.7%). The majority of patients (81.8%) had radicular LBP, while 16 patients (18.1%) had only LBP. Predominantly, 55.6% of all patients were taking NSAIDs. Levels of all adaptor molecules were highest in the MC I group and lowest in the MC III group. The levels of IRF3, TICAM1, TICAM2, NF-kB p65, TRAF6, and TLR4 were significantly increased in the MC I group compared to the MC II and MC III groups. The variations of the individual adaptor molecules showed no statistically significant difference in the use of NSAIDs and radicular LBP. CONCLUSION: As a result of the impact assessment, the current study clearly demonstrated for the first time that the TRIF-dependent signalling pathway plays a crucial role in the degeneration process in human lumbar intervertebral disc specimens. © 2023. All Right Reserved.Publication Metadata only Is the modular dynamic system as effective as classical dynamic systems in long segment dynamic thoracolumbar stabilization?(Turkish Neurosurgical Society, 2024) N/A; Günerbüyük, Caner; Akgün, Mehmet Yiğit; Özer, Ali Fahir; School of Medicine; Koç University HospitalAIM: To evaluate the outcomes of dynamic stabilization in the multilevel degenerative spondylotic spine, and to compare the two dynamic systems (Dynesys (R) and Orthrus (R)) to reveal the increasing role of dynamic systems in the management of the degenerative spine. MATERIAL and METHODS: A total of 74 patients who received dynamic stabilization for degenerative pathologies were retrospectively analyzed. Demographic details: preoperative data including neurological status, pain scores, and radiology; and intraoperative data including blood loss, duration of surgery, complications, and postoperative data including the neurologic status, duration of hospital stay, and pain scores were examined. RESULTS: Patients in both groups showed statistically significant improvements in their Visual Analog Scale and Oswestry Disability Index scores. Significant corrections of thoracic kyphosis (T2 -T12), the sagittal vertical axis, and T10 -L2 thoracolumbar kyphosis were obtained in our cohort (p<0.05). A total of 4 patients received revision surgery due to screw loosening. Patients were discharged after 3-4 days and mobilized on the first postoperative day. CONCLUSION: We did not experience any serious issues in terms of stabilization in the cases in which we employed both systems. Our patients' clinical results were satisfactory in both systems. Existing systems can be used safely even in long -segment stabilization surgeries.Publication Metadata only Transient ageusia and dysgeusia following thalamic cyst drainage(Turkish Neurosurgical Society, 2024) N/A; Nokay, Aziz Emre; Erden, Mert Emre; Samancı, Mustafa Yavuz; Peker, Selçuk; School of MedicineTaste consists of sensation and perception. Specific neural structures transmit a stimulus from the taste buds to the gustatory cortex to generate taste sensation. Any disruption of this pathway, whether it affects sensation or perception, can result in taste disorders. Stereotactic procedures involving the thalamus may result in gustatory complications. A 41-year-old female patient who underwent stereotactic drainage of a thalamic cyst suffered transient ageusia. Subsequently, she developed metallic taste perception. When her stereotactic plan was re-evaluated, it was noted that the posteromedial ventral thalamus nucleus was in the path of the needle tract and the needle had passed through it. Follow-up was recommended and her symptoms completely resolved within 2 months following surgery. Modern imaging techniques allow for the visualization of neural structures related to the sense of taste. Additionally, care must be taken when planning stereotactic procedures for such lesions.Publication Metadata only Does long segment subarachnoido-subarachnoid shunt prevent posttraumatic and postinfectious spinal arachnoid cyst recurrence?: technical note and case series(Elsevier Masson S.R.L., 2024) ; Akgün, Mehmet Yiğit; Ateş, Özkan; Akyoldaş, Göktuğ; Öktenoğlu, Bekir Tunç; Tepebaşılı, Mehmet Ali; Sasani, Mehdi; Özer, Ali Fahir; ; School of Medicine; Koç University HospitalSyringomyelia associated with extensive spinal adhesive arachnoiditis (SAA) can be defined as a rare but progressive disease with potentially devastating clinical consequences. Diagnosis can be challenging due to the absence of specific clinical findings, confusion with other pathologies, and late imaging modalities. The treatment strategy for syringomyelia associated with extensive SAA should include direct drainage of the syringomyelia, and dissection of the adhesive arachnoid with expansive duraplasty. Hence, several approaches have been reported for arachnoid dissection and decompression of the subarachnoid space. The high risk of recurrence after the operation is one of the most challenging situations. First two cases were operated previously, and the cyst walls were removed and anastomosed to the intact subarachnoid space at the upper and lower ends by each other. However, in both cases, the cyst recurred after a short time and they were anastomosed again in our clinic. A subarachnoid-subarachnoid shunt was placed with a multi-hole silicone tube extending to the proximal and distal intact subarachnoid spaces and passing through the cyst removal area. In our third case, the shunt system we described was applied directly, and satisfactory results were obtained in the clinical follow-up of the patient. It has been demonstrated that subarachnoido-subarachnoid shunt is a very satisfactory treatment option for this type of pathology, which is difficult to follow and treat. © 2024 Elsevier Masson SASPublication Metadata only Efficacy and advantages of spinal anesthesia in lumbar disk surgery(Thieme Medical Publ Inc, 2024) Akgul, Mehmet Huseyin; Akgün, Mehmet Yiğit; Orak, Helin İlkay; Ateş, Özkan; School of Medicine; Graduate School of Health Sciences; Koç University HospitalBackground Quality of life (QoL) may be affected due to various reasons such as low back or leg pains with accompanying neurologic problems. Lumbar disk surgery is one of the most common performed surgeries to relieve those symptoms. Various anesthetic techniques can be used safely to perform lumbar disk surgeries. Properties that make an anesthetic technique good are mainly the quick onset and returning of the effects. This large retrospective study with patients who have undergone lumbar disk surgery under spinal anesthesia aims to evaluate the perioperative and postoperative parameters of the spinal anesthesia and review the literature. Methods Cases operated under spinal anesthesia between January 2017 and December 2020 were investigated, and 617 patients who underwent simple lumbar disk surgery were included in the study. Demographic characteristics and American Society of Anesthesiologists (ASA) physical status of the patients were recorded. Visual analog scale (VAS) and QoLscores were obtained before and after the operation. Results There were 282 (45.7%) male and 335 (54.3%) female patients with a mean age of 39.48 +/- 16.71 years (range: 18-58 years) at symptom onset. The mean operating time was 46.3 minutes (range: 22-68 minutes). Average blood loss was 85 mL (range: 55-125 mL). All the patients were mobilized 6 to 12 hours after surgery. In our patient group, there were both high- and normal-risk groups in terms of the ASA physical status. During the clinical follow-up, a statistically significant improvement was found for the VAS and QoL scores ( p < 0.05). Conclusions In this large retrospective study, our results have confirmed that spinal anesthesia is at least comparable to general anesthesia and even superior to it in some aspects.Publication Metadata only Efficacy of hypofractionated Gamma Knife radiosurgery in treating surgical beds of metastatic brain tumors(Elsevier Sci Ltd, 2024) Samancı, Mustafa Yavuz; Tepebaşılı, Mehmet Ali; Ardor, Gökçe Deniz; Düzkalır, Ali Haluk; Askeroğlu, Mehmet Orbay; Peker, Selçuk; School of Medicine; Koç University HospitalObjective: Surgery alone for metastatic brain tumors (METs) often results in local recurrence due to microscopic residual tumor tissue. While stereotactic radiosurgery (SRS) is commonly used post-surgery, hypofractionation may be required for large surgical beds. This study evaluated the efficacy and safety of hypofractionated Gamma Knife radiosurgery (hf-GKRS) for the first time as a post-operative adjuvant therapy. Methods: This retrospective study involved 24 patients (28 surgical beds) who underwent hf-GKRS within four weeks after surgery. The study primarily focused on local control (LC) rate and analyzed distant intracranial failure (DICF), intracranial progression-free survival (PFS), leptomeningeal disease (LMD), overall survival (OS), and radiation necrosis (RN). Results: During a median follow-up of 9 months, LC was achieved in 89.3 % of surgical beds. LC estimates at 6, 12, and 24 months were 96.4 %, 82.7 %, and 82.7 %, respectively. DICF was observed in 45.8 % of patients, and LMD was identified in two patients (8.3 %). At the end of the follow-up, 58.3 % of patients were alive, and the median OS was 20 months. RN occurred in only one surgical bed (3.6 %). No grade 5 toxicity was observed. The univariate analysis identified a longer interval to GKRS (HR 11.842, p = 0.042) and a larger treatment volume (HR 1.103, p = 0.037) as significant factors for local failure. Conclusions: hf-GKRS shows potential as an effective and safe adjuvant treatment for surgical beds. It offers an alternative to SRS, SRT, or WBRT, particularly for larger volumes or tumors near critical structures. Further research is needed to confirm these results and optimize treatment approaches.Publication Metadata only Gamma Knife radiosurgery for multiple sclerosis-associated trigeminal neuralgia(Elsevier Sci Ltd, 2024) Özlük, Gülşah Özturk; Samancı, Mustafa Yavuz; Düzkalır, Ali Haluk; Şenyürek, Şükran; Askeroğlu, Mehmet Orbay; Peker, Selçuk; School of Medicine; Koç University HospitalBackground: Gamma Knife radiosurgery (GKRS) has well-known efficacy in the treatment of idiopathic trigeminal neuralgia (TN). However, few studies have evaluated the effects of GKRS in the treatment of multiple sclerosis (MS)-related TN. This study analyzed the efficacy and complications of GKRS for MS-related TN. Methods: This retrospective study included 28 MS-related TN patients who underwent GKRS with a median follow-up of 27 (range, 12-181) months. The cisternal segment of the trigeminal nerve was targeted with a median radiation dose of 80 (80-90) Gy. Pain intensity was assessed using Barrow Neurological Institute (BNI)Pain Intensity Scores (BNI-PIS). Before GKRS, all patients suffered from BNI pain levels of 4 or 5. A reduction in pain to BNI 3b or below was deemed as adequate pain relief. Results: The initial proportion of patients who experienced adequate pain relief was 71.4%, with a median interval of 21 (1-45) days. At the final follow-up, 50% of patients had achieved adequate pain relief. Ten patients (35.7%) suffered from complications, including four with facial sensorial dysfunctions, four with a decline in their corneal reflexes, and two with jaw weakness. Among the 20 initial responders, six (30%) patients suffered pain recurrence after a median interval of 35 (12-180) months. Conclusions: GKRS is an effective means of pain relief in MS-related TN, but has side effects that are relevant to other ablative treatments. The benefits and risks of GKRS should be discussed with patients who wish to avoid surgery or when previous treatments fail.Publication Metadata only The clinical value of amplitude-integrated electroencephalography in a historical cohort with neonatal encephalopathy: a comparison of short-term versus prolonged-period monitoring(Elsevier Sci Ltd, 2024) Tekgül, Hasan; Yalaz, Mehmet; Kanmaz, Seda; Terek, Demet; Aktan, Gül; Köroğlu, Özge A.; Yılmaz, Sanem; Akisu, Mete; Kültürsay, Nilgün; Akçay, Ayfer Arduç; School of MedicineBackground: To compare the amplitude -integrated electroencephalography (aEEG) monitoring (short-term versus prolonged -period) for neonatal seizure detection and outcome. Methods: The aEEG monitoring in a historical cohort (n = 88, preterm:42, and term:46) with neonatal encephalopathy between 2010-2022 was re-evaluated for neonatal seizures (electrographic, electro-clinical, and clinical seizures) and EEG background scoring. The cohort was dichotomized: group I (short -period with 6-12 h, n = 36) and group II (prolonged -period with 24-48 h, n = 52). Both monitoring types were evaluated for the diagnostic accuracy of the "patients with seizures" and for outcome characteristics (early death as well as adverse outcomes at 12 months of age). Results: A total of 67 (76 %) neonates of the cohort were diagnosed as "patients with seizures": electrographiconly seizures in 10 (15 %), electro-clinical seizures in 22 (33 %), and clinical -only seizures in 35 (52 %). The aEEG provides the "patients with seizures" in neonates with a 36.5 % rate with both types of monitoring: 17/36 (47.2 %) with short-term and 15/52 (28.8 %) with prolonged -period monitoring. The prolonged period aEEG had higher diagnostic values for seizure detection ( sensitivity = 0.73 and negative predictivity value = 0.81 ). However, the aEEG background scores were similar for both types of aEEG monitoring, respectively ( the mean +/- SD: 4.73 +/- 2.9 versus 4.4 +/- 4. p = 0.837 ). The aEEG scoring was correlated with the magnitude of brain injury documented with MRI, the early death, and the adverse outcome at 12 months of age. Conclusions: Both aEEG types are valuable for monitoring the "patients with seizures" and outcome characteristics.Publication Metadata only Combined central and peripheral demyelination: two case reports(KARGER, 2024) Belen, Buse Gül; Bülbül, Nazlı Gamze; Karşıdağ, Sibel; Köse, Ercan; Özdag, Fatih; Vural, Atay; School of MedicineCombined central and peripheral demyelination (CCPD) is a rare disease characterized by demyelinating lesions in both the central nervous system (CNS) and peripheral nervous system (PNS). CCPD can present with acute, subacute, or chronic onset. The initial symptom may be of CNS origin, PNS origin, or both. The clinical manifestations of CCPD are quite heterogeneous, and there are no well-defined diagnostic criteria. In MRI imaging of CCPD cases, demyelinating lesions can be seen in areas such as the brain, cerebellum, brainstem, optic nerve, and spinal cord. Common electromyography (EMG) findings in patients with CCPD include decreased motor nerve conduction velocities, decreased or absent sensory nerve action potentials, prolonged F-wave latency, and decreased amplitude of compound muscle action potentials. Neurofascin (NF) is a transmembrane protein and anti-neurofascin (anti-NF) antibodies directed against NF can be positive in cases of CCPD. Four main NF polypeptides are produced by alternative splicing: NF 186, NF 180, NF 166, and NF 155. The investigation of anti-NF in CCPD cases is therefore important for etiological considerations. Here, we discussed three cases diagnosed with CCPD based on clinical, neuroimaging, EMG, and anti-NF antibody results in light of the literature.