Researcher: Hergünsel, Ömer Batu
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Hergünsel, Ömer Batu
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Publication Metadata only The effectiveness of antibiotic-coated ventriculoperitoneal shunts for prevention of shunt ınfections in patients with myelomeningocele(Karger, 2021) Ertugrul, Bilal; Kaplan, Metin; Akgun, Bekir; Öztürk, Sait; Erol, Fatih Serhat; N/A; Hergünsel, Ömer Batu; Doctor; N/A; Koç University Hospital; N/APurpose: Hydrocephalus is a common comorbidity among the newborns, with myelomeningocele (MMC) and ventriculoperitoneal (VP) shunts being frequently used for the treatment of such patients. In this study, we aimed to compare the effectiveness of antibiotic-free and antibiotic-coated shunts to reduce the rate of shunt infection in patients with hydrocephalus and accompanying MMC. Methods: 116 patients with hydrocephalus and MMC who were treated with VP shunts were included in the study. Shunt infection rates among antibiotic-free and antibiotic-coated shunts were compared. Results: of the 116 patients included in the study, 39 had antibiotic-coated shunts and 77 had antibiotic-free shunts. Shunt infection developed in 4 of the 39 cases treated with antibiotic-coated shunts and in 5 of the 77 cases treated with shunts without antibiotics. No significant statistical difference was found between antibiotic-coated and antibiotic-free VP shunts in terms of shunt infection (p = 0.450, p > 0.05). Conclusion: In patients with MMC, using VP shunts containing antibiotics was found not to have a protective effect in preventing shunt infection. Whether the sac is intact or ruptured does not affect this result.Publication Metadata only Gamma knife radiosurgery for pituitary spindle cell oncocytomas(Elsevier, 2019) Ozdemir, Inan Erdem; Sengoz, Meric; Akyoldaş, Göktuğ; Hergünsel, Ömer Batu; Peker, Selçuk; Faculty Member; Doctor; Faculty Member; School of Medicine; N/A; School of Medicine; Koç University Hospital; 203677; N/A; 11480Objectives: Spindle cell oncocytomas (SCOs) are benign lesions of the posterior portion of the pituitary gland that typically come to neurosurgical attention due to compression of the sellar or parasellar structures, and headaches. Initial treatment options for SCOs include surgical resection, particularly via the transsphenoidal approach. However, given that initial resection tends to be insufficient and subsequent revision surgery carries high complication risk, adjuvant treatment modalities may appear to offer promising solutions for controlling tumor progression. This report focuses on a potential new therapeutic option for SCOs, gamma knife radiosurgery (GKRS). Patients and methods: The authors identified all patients at one center who had a pituitary lesion treated with GKRS between 2005 and 2016. Five patients with histopathologically confirmed SCO who underwent GKRS were retrospectively identified and included in the present study Results: The mean patient age was 52 years (range, 41-61 years). The most common presenting symptom was visual disturbance. All five patients had a history of transsphenoidal surgical resection prior to GKRS therapy. The mean tumor volume was 2.25 cm(3) (range 0.7-5.38 cm(3)). The median tumor margin dose was 12 Gy (range, 12-14 Gy), and the median maximal dose was 24 Gy (range, 24-35 Gy). The median isodose was 50 (range, 40-50). No tumor volume progression was observed during radiological follow-up after GKRS (mean, 52 months; range, 36-84 months). At last follow-up, no neurological, endocrinological, or visual complications had been observed. Conclusion: Given their highly vascular and adherent nature, SCOs can be challenging tumors to treat, in particular when they recur. In our five cases, GKRS provided excellent tumor volume control for approximately 4.3 years on average. These results suggest that GKRS is a safe and effective treatment modality for histopatholo-gically confirmed residual SCO.Publication Metadata only Applications of radiosurgery for pain management(Türk Nöroşirurji Derneği, 2019) Peker, Selçuk; Hergünsel, Ömer Batu; Faculty Member; Doctor; School of Medicine; N/A; N/A; Koç University Hospital; 11480; N/ARadiosurgery is the irradiation of tissue with a high radiation dose in a single fraction or a few fractions. Radiosurgical planning for the treatment of pain differs from that for tumors or arteriovenous malformations. In order to achieve ablative effects in target tissue, higher doses of radiation are used and the total dose is applied to a lower volume to minimize the impact to surrounding tissue. Currently, primary applications of radiosurgery for pain are cranial-nerve-related conditions such as trigeminal neuralgia and glossopharyngeal neuralgia. In addition, radiosurgery can be performed either together with other treatment modalities or as a stand-alone treatment for cluster headache, chronic intractable malignant pain syndromes and pain due to spinal tumors. / Radyocerrahi, yüksek dozda radyasyonun tek ya da az sayıda seansta hedef dokuya uygulanması işlemidir. Ağrı tedavisi için yapılan radyocerrahi planlamaları, tümör ya da vasküler malformasyonların tedavisinde yapılan planlamalara göre bazı farklılıklar göstermektedir. Hedef dokuda ablatif etkilerin ortaya çıkması için daha yüksek radyasyon dozları kullanılmakta ve çevre dokunun etkilenmesini en aza indirmek amacıyla toplam doz, daha düşük bir hacme uygulanmaktadır. Günümüzde ağrı tedavisinde radyocerrahinin başlıca uygulama alanları, trigeminal nevralji ve glossofaringeal nevralji gibi kranial sinir kaynaklı durumlardır. Ek olarak, küme baş ağrısı, kronik dirençli kanser ağrısı sendromları ve spinal tümörler kaynaklı ağrılarda radyocerrahi, diğer tedavi seçenekleri ile birlikte ya da tek başına kullanılabilmektedir.Publication Open Access Relation between ILAE hippocampal sclerosis classification and clinical findings in temporal lobe epilepsy(Turkish Neurosurgical Society, 2021) Haşimoğlu, O.; Barut, O.; Kapar, M.O.; Kınay, D.; Gül, G.; Dirican, A.C.; Bilgiç, B.; Tuğcu, B.; Hergünsel, Ömer Batu; Faculty Member; Koç University HospitalAim: to investigate the relationship between clinical features and prognosis of the hippocampal sclerosis (HS) cases and International League Against Epilepsy (ILAE) histopathology classification. Material and methods: a hundred patients with refractory epilepsy who were operated with the diagnosis of the Mesial Temporal Lobe Epilepsy were included in the study. Socio-demographic characteristics, clinical and family histories, post-operative ILAE and Engel epilepsy scores and diagnostic tests were recorded. At the same time, all of the pathological specimens were classified according to the new semi-quantitative ILAE classification. A significant statistical relationship was investigated between clinical data and HS-ILAE groups. RESULTS: There were 36 male 64 female patients. The mean follow-up period was 6.5 years. 75% of the cases were HS-ILAE type 1, 19% HS-ILAE type 2, 6% were unidentifiable. FCD3A was detected in 3 patients. The HS-ILAE Type 2 ratio was high on the right-sided cases. In addition, HS-ILAE Type 1 ratio was high in patients with early seizure onset and long duration of epilepsy. There was no significant relationship between long-term ILAE and Engel epilepsy outcome scores and HS-ILAE types. Conclusion: resection of mesiotemporal structures in hippocampal sclerosis provides seizure control in at least two-thirds of cases. Histopathological findings may help us understand the epileptogenicity-prognosis of HS. The relationship between ILAE histopathology classification and clinical factors will become more obvious in the future. According to our study, there was a relationship between onset age of epilepsy, epilepsy duration, lesion side and HS-ILAE types. The reinforcement of these relationships with larger series will benefit clinicians.Publication Open Access Gamma Knife radiosurgery for anterior clinoid process meningiomas: a series of 61 consecutivepatients(Elsevier, 2020) YIlmaz, Meltem; Şengöz, Meriç; N/A; Akyoldaş, Göktuğ; Hergünsel, Ömer Batu; Peker, Selçuk; Faculty Member; Graduate School of Health Sciences; School of Medicine; N/A; N/A; 11480Objective: gamma Knife radiosurgery (GKRS) outcomes for anterior clinoid process (ACP) meningiomas have not been specifically reported within any meningioma series. We present the initial and largest series in the literature that describes the presenting features, radiosurgery parameters, and radiologic and long-term clinical outcomes for 61 patients with ACP meningiomas treated with GKRS. Methods: medical records were reviewed for 61 consecutive patients at a single center who underwent GKRS for ACP meningioma between 2008 and 2016. Results: of 61 patients with ACP meningiomas, 49 (80%) were treated with GKRS as primary treatment, and 12 (20%) were treated with GKRS as an adjuvant therapy. Before GKRS, 29 patients presented with visual impairment and 50 patients presented with headache. Median patient age was 54.9 years. Median tumor volume was 3.2 cm(3), and median margin dose was 12.0 Gy. The median radiologic follow-up time after GKRS was 75 months. During follow-up, tumor volume regressed in 37 cases (61%) and remained unchanged in 24 cases (39%). None of the patients experienced tumor volume progression. Tumor volume <3 cm(3) was an independent predictor of tumor volume regression after GKRS (univariate analysis, P = 0.047; multivariate analysis, P = 0.049). Of 29 patients who presented with visual impairment, 16 (55%) improved after GKRS. None of the 61 patients developed new neurologic deficits after GKRS. Conclusions: GKRS provides a high rate of tumor volume control for ACP meningiomas as well as a low complication rate. Excellent tumor volume control was associated with smaller tumor size only.