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Publication Metadata only A new technique for the surgical treatment of atlantoaxial instability: C1 lateral mass and C2-3 transfacet screwing(Turkish Neurosurgical Soc, 2018) N/A; N/A; N/A; N/A; Şentürk, Salim; Akyoldaş, Göktuğ; Yaman, Onur; Özer, Ali Fahir; Doctor; Faculty Member; Doctor; Faculty Member; N/A; School of Medicine; N/A; School of Medicine; Koç University Hospital; N/A; Koç University Hospital; N/A; 203677; 219524; 1022Atlantoaxial instability is a special entity that may be caused by many disorders such as trauma, tumor, arthritis, congenital malformation and infection. Atlantoaxial fixation is needed to provide stability, prevent neurological deficits and correct deformity. The aim of this report is to introduce an alternative technique for the treatment of atlantoaxial instability in patients who have vertebral artery anomaly, anomalous C2 or osteoporosis. C1-2-3 fixation was performed in a 50-year-old male patient with atlantoaxial instability due to os odontoideum. C1 lateral masses were identified and screw placement was performed. C2 facet joints were identified bilaterally. The superior margin of the junction of pedicle and the lamina was used as the entry point and 3.5x22 mm screws were inserted from C2 facet joint to the C3 facet joint in the mediolateral and craniocaudal direction under fluoroscopic guidance with caution. The posterior fixation screws were interconnected with two rods. Finally, autologous grafts were placed posterolaterally to encourage the fusion. The patient"s complaints were relieved after the surgery. C1-C2 instability was not seen in the postoperative radiological examinations. In the surgical treatment of C1-2 instability, our technique could help reduce the possibility of vertebral artery injury in patients who have a vertebral artery course anomaly or when it is difficult to place C2 pedicle screws due to anomalous C2 pedicles and osteoporosis. High fusion rate could be achieved with this technique due to passing through the four cortical surfaces. No wire or allograft was required. Thus, the instrumentation cost could be reduced.Publication Open Access A novel modular dynamic stabilization system for the treatment of degenerative spinal pathologies(Turkish Neurosurgical Society, 2019) Çevik, Orhun Mete; Erbulut, Deniz Ufuk; Goel, Vijay; N/A; Özer, Ali Fahir; Yaman, Onur; Şentürk, Salim; Öktenoğlu, Bekir Tunç; Sasani, Mehdi; Süzer, Süleyman Tuncer; Faculty Member; Doctor; Doctor; Faculty Member; School of Medicine; 1022; N/A; N/A; N/A; N/A; 221691Aim: to show the preliminary clinical results of the Orthrus modular dynamic stabilization system that is a new instrumentation system intended for degenerative diseases of the lumbar spine. Material and methods: the system utilizes two different types of screws that can be used in conjunction with different types of rods such as titanium, carbon fiber or PEEK. The first type of screw is a double headed screw to interconnect to the upper and lower level with independent rods. The second type of screw is a sliding screw to be used on a immovable vertebrae that allows movement in two planes on the tip. Results: the system has been used on 36 patients with pathology varying from degenerative disc disease to degenerative lumbar scoliosis. Satisfactory results have been obtained in a all 36 patients in the 12-month follow-up period. Conclusion: the Orthrus dynamic system shows better clinical results than the available dynamic systems on the market. It also proves to provide similar fusion with considerably less postoperative morbidity which makes it a better method to treat adult degenerative spine diseases for carefully chosen patients.Publication Metadata only A potential therapeutic pitfall in the treatment of venous reflux due to variant planar anatomy of varicose segments(Sage, 2018) N/A; N/A; N/A; N/A; Deniz, Sinan; Türeli, Derya; Erkan, Burcu; Oğuzkurt, Levent; Doctor; Doctor; Faculty Member; Faculty Member; N/A; N/A; School of Medicine; School of Medicine; Koç University Hospital; N/A; N/A; N/A; 13559Purpose To elaborate on a planar anatomic variant of great saphenous vein as a potential therapeutic pitfall in the treatment of venous reflux. Materials and methods Lower extremity veins in 568 limbs with great saphenous vein insufficiency were sonographically mapped. A rather overlooked variation, the saphenous bow, was studied with emphasis on anatomic clarification and its involvement in venous insufficiency. Results This variation, observed in 5.1% (n=29) of limbs, comprised two segments; one uninterrupted great saphenous vein proper coursing throughout saphenous compartment and one extra-compartmental segment originating distally from and proximally fusing with it. Venous arch remains within compartment only briefly during take-off and re-entry. Extra-compartmental venous arch had reflux either alone (10.3%) or together with intra-compartmental segment (75.9%). Conclusion This variation, part of saphenous segmental aplasia/hypoplasia complex, is associated with venous insufficiency. Meticulous mapping of great saphenous vein territory and identification of such variants during planning stage is indispensable for optimal clinical outcomes of treatment.Publication Metadata only A unique case of intradural communicating branches between the accessory nerve and the dorsal roots of the cervical spinal nerves(Thieme Medical Publ Inc, 2013) Şeker, Aşkın; Ceylan, Davut; Tatarlı, Necati; Abdullaev, Tuychiboy; Gülbar, Seda; Konya, Deniz; Bayri, Yaşar; Kılıç, Türker; N/A; Keleş, Güven Evren; Çavdar, Safiye; Faculty Member; Faculty Member; School of Medicine; School of Medicine; N/A; 1995Objective The accessory nerve has cranial and spinal roots. The cranial roots emerge from the medulla, whereas the spinal roots arise from motor cells within the ventral horn of C1-C7 segments of the spinal cord. Communications have been described between the spinal accessory nerve rootlets and the dorsal rootlets of cervical spinal nerves. In the present case, we report a communication that has not been reported before and discuss the functional anatomy. Materials and Methods During the dissection of the craniovertebral junction of a 67-year-old formalin-fixed adult male cadaver, a connection between the spinal accessory nerve rootlets and the dorsal rootlets of the cervical spinal nerves was observed. Results A communication between the spinal rootlets of the accessory nerve and the dorsal roots of cervical spinal nerves was present on the right and left side. On the right, a communication between the accessory nerve spinal rootlet and the dorsal rootlet of the fourth cervical spinal nerve existed. On the left, there were two branches from the lowest accessory nerve spinal rootlet, one run ventrally and the other dorsally to the spinal rootlet and reached the dorsal root of third cervical spinal nerve. The dorsal root of C1 did not exist on either the right or the left side. Further, an unusual spinal accessory nerve formation was also observed. Discussion This case does not fit into any of the previously described classifications in the literature. Therefore, the different variations concerning the communications between the spinal rootlets of the accessory nerve and the cervical spinal nerves should be kept in mind during both surgical, especially radical neck dissections, and nonsurgical evaluations.Publication Metadata only A variation of the cords of the brachial plexus on the right and a communication between the musculocutaneous and median nerves on the left upper limb: a unique case(Thieme Medical Publishers, 2013) Tatarli, Necati; Ceylan, Davut; Hacioglu, Husniye; Uygun, Seda; Seker, Askin; Çavdar, Safiye; Keleş, Güven Evren; Faculty Member; Faculty Member; School of Medicine; School of Medicine; 1995; N/ADuring routine anatomical dissection of the upper extremity of a 64-year-old cadaver for educational purposes, we observed variations in the brachial plexus on each side. On the right an anomaly of cord formation was present and on the left there was a communication between the musculocutaneous nerve (MCN) and median nerve (MN). On the right side the brachial plexus showed two trunks, superior (C5 and C6) and inferior (C7, C8, and T1); the middle trunk was absent. The superior trunk bifurcated into anterior and posterior divisions, the anterior division continued as the lateral cord forming the MCN. The posterior division gave off the subscapular branch. The inferior trunk trifurcated into radial, median, and ulnar nerves. The radial nerve gave off the axillary and thoracodorsal nerves. The ulnar nerve gave off the median cutaneous nerves of the arm and forearm. The median nerve received a small ascending branch from the MCN. On the right side, there was a communicating branch from the MCN to the MN in the lower third of the arm region. This communicating branch also gave rise to a muscular branch to the brachialis muscle and the lateral cutaneous nerve of forearm. No additional heads of the biceps brachii muscle were observed in either upper limb. Knowledge of the variations of the brachial plexus in humans can be valuable for operations of the shoulder joint and its repair for providing an effective block or treatment for anesthetists and also for explaining otherwise incomprehensible clinical signs for neurologists.Publication Metadata only Abo and rh blood groups and risk of myelomeningocele(Turkish Neurosurgical Soc, 2020) Isik, Semra; Cevik, Serdar; Turhan, Ali Haydar; Hanimoglu, Hakan; N/A; Baygül, Arzu Eden; Faculty Member; School of Medicine; 272290AIM: To investigate the relationship between the distribution of ABO or Rhesus (Rh) blood group antigens and the incidence of myelomeningocele. MATERIAL and METHODS: A retrospective data was reviewed for all myelomeningocele patients operated at a tertiary academic hospital between years 2014 and 2019. Age, sex, delivery method, physical and neurological examination findings, and radiological findings alongside with blood type of each patient were recorded. The data of blood group distribution among the study patients was compared to the data of healthy individuals in the same region. RESULTS: Patients with group B and AB showed a higher chance of developing myelomeningocele. Rh-positive blood group was associated with high incidence of myelomeningocele (93.5%), whereas Rh-negative blood group showed least association (6.5%). Rh-positive blood group was also found to be more frequent in patients with myelomeningocele with hydrocephalus and Chiari malformation. CONCLUSION: The findings of this study show that ABO and Rh blood groups have an effect on the development of myelomeningocele under the influence of environmental or genetic factors.Publication Metadata only Acute kidney injury after pediatric liver transplantation(Elsevier, 2019) Ferah, Oya; Açık, Mehmet Eren; Gökkaya, Zafer; Acar, Umut; Yenidunya, Özlem; Yentur, Ercüment; Tokat, Yaman; N/A; Akbulut, Akın; Doctor; N/A; Koç University Hospital; N/AN/APublication Metadata only Acute-onset hemiparkinsonism secondary to subacute-chronic subdural hematoma(Turkish Neurosurgical Soc, 2022) Özekmekçi, Sibel; Şenel, Gülçin Benbir; N/A; Ertan, Fatoş Sibel; Çakmak, Özgür Öztop; Peker, Selçuk; Faculty Member; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; Koç University Hospital; 112829; 299358; 11480Subdural hematomas constitute rare causes of secondary Parkinsonism in elderly. Subacute or chronic subdural hematomas occur in the elderly following minor head trauma or even without a remarkable history of trauma. A 69-year-old woman admitted with a rapidly progressive acute-onset hemiparkinsonism on the left side of her body. She denied any precipitating event before the onset of her symptoms, and her medical history was unremarkable. The anti-Parkinsonian therapy showed no benefit, but gradually worsening of the symptoms was observed. Her brain magnetic resonance imaging revealed a large subacute-chronic subdural hematoma on the right side with a mass effect on the basal ganglia structures, contralateral to her symptomatology. On thorough questioning, she confessed to having fallen out of the bed at night almost four weeks ago, three-weeks before the onset of her symptomatology. She had no complications associated with this fall and merely remembered this event. She denied any history of rapid eye movements (REM) sleep behavior disorder. The anti-Parkinsonian treatment was discontinued; the subdural hematoma was evacuated via burr hole drainage surgery. Her symptoms disappeared instantly after the surgery, with a normal neurologic examination one week after the surgery.Publication Open Access Aesthetic earlobe reduction: a practical geometric modification with natural contour preservation(Thieme Medical Publishers, 2019) N/A; Sezgin, Billur; Tatar, Sedat; Faculty Member; School of Medicine; 133762; N/AEarlobe elongation is one of the signs of aging process and surgical correction is warranted for earlobe ptosis. Most of the earlobe reduction techniques result with scars on the anterior or inferior aspect of the earlobe or unnatural appearance. The authors present a modified technique for earlobe reduction and reshaping that results with an acceptable scar set on the natural groove of the anterior surface of the earlobe. Nine healthy female patients were operated for earlobe reduction. The postoperative and preoperative otobasion inferius (O)-subaurale (S) distances of these patients were evaluated. According to the measurements, the preoperative mean O-S distance of the right lobule was 13.1 +/- 1.8mm and the left lobule was 12.8 +/- 1.9mm, while the postoperative O-S distance of the right side was 3.4 +/- 1mm and the left side was 3.4 +/- 0.7mm ( Table 2 ). This translated to an approximate pre- and postoperative O-S distance difference of 9mm, a significant reduction that resulted with ideal O-S values. The presented approach has numerous advantages including inconspicuous scarring, smooth lateral earlobe contours, and undisturbed free borders. This was a Level IV therapeutic study.Publication Open Access An investigation into the correlation of scalp electrophysiological findings with preoperative clinical and imaging findings in patients with focal cortical dysplasia(Turkish Neurosurgical Society, 2022) Gürkan, Zahide Mail; Kapar, Özge; Yeni, Seher Naz; Bilgiç, Bilge; Gürses, Rabia Candan; Faculty Member; School of Medicine; 110149Aim: to evaluate the patients who had epilepsy surgery and pathologically proven focal cortical dysplasia (FCD) in order to further classify and discuss electroencephalography (EEG) findings in different pathological subtypes. Material and methods: this study included 19 refractory epilepsy patients who underwent surgery between 1999 and 2017 in the Istanbul Faculty of Medicine. Demographic data, preoperative examinations, scalp video EEGs, and postoperative outcomes were evaluated retrospectively. Results: In this study, 36.8% of the patients were female. The mean age was 21.89 ± 14.64 years. Rhythmic epileptiform discharges (RED) were observed in 31.6%. 37.5% of the patients with isolated intermittent spike/sharp waves were type I, 50% were type II, and 12.5% were type III. 100% of the patients with normal background activity were FCD type II. 67% of the patients with asymmetric slowing were FCD type I, 22% was FCD type II, 11% were FCD type III. 71% of the patients with symmetrical slowing were FCD type I, 29% were FCD type II. One patient had Frontal Intermittent Rhythmic Activity, one patient had Electrical Status Epilepticus in Slow Sleep, two patients had “burst suppression,” and one patient had a “switch of” sign. The frequency of focal epileptogenic activity was higher when there was an FCD lesion on magnetic resonance imaging. Conclusion: the findings obtained in this study did not reveal any distinctive electrophysiological features in FCD and subgroups of FCD. The incidence of REDs did not differ between types. The frequency of isolated intermittent sharp/spike waves was higher in type II than I. Intermittent and continuous EEG slowing was more commonly seen among FCD Type I patients.