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Öğe Clinical study of decompressive craniectomy in children(Turkish Neurosurgical Soc, 2020) Göker, Burcu; Güçlü, D. Güçlühan; Dolaş, İlyas; Özgen, Utku; Altunrende, M. Emre; Akıncı, A. Tolgay; Şencan, Fahir; Aydoseli, Aydın; Can, Halil; Sencer, AltayAIM: To evaluate the clinical characteristics of children who recently underwent decompressive craniectomy (DC) due to elevated intracranial pressure (ICP) correlated to head trauma or other causes, such as ischemic insult. MATERIAL and METHODS: Twelve patients aged <= 17 years who underwent DC due to elevated ICP between 2013 and 2018 were included in the study. The clinical status of the participants, radiological characteristics, type and timing of surgery, and outcomes were recorded. RESULTS: Three female and nine male patients with a mean age of 10 years were included. The initial average Glasgow Coma Scale score was 6 (3-12). All patients presented with signs of diffuse cerebral edema and subdural hematoma of various sizes along with other intracranial pathologies. Only one patient required bilateral frontal craniectomy. In the postoperative period, three patients died, and three had severe disability. CONCLUSION: With the increasing use and success of DC in adults, this procedure can also be effective in children. Considering brain differences in children, large and well-structured clinical trials must be conducted to prevent complications and to identify the best technique, timing, and benefits of DC for children.Öğe Feasibility of allogeneic mesenchymal stem cells in pediatric hypoxic-ischemic encephalopathy: phase I study(Baishideng Publishing Group Co, 2021) Kabataş, Serdar; Civelek, Erdinç; Savrunlu, Eyüp Can; Kaplan, Necati; Boyalı, Osman; Diren, Furkan; Can, Halil; Genç, Ali; Akkoç, Tunç; Karaöz, ErdalBackground Hypoxic-ischemic encephalopathy (HIE) is one of the leading causes of death and long-term neurological impairment in the pediatric population. Despite a limited number of treatments to cure HIE, stem cell therapies appear to be a potential treatment option for brain injury resulting from HIE. Aim To investigate the efficacy and safety of stem cell-based therapies in pediatric patients with HIE. METHODS The study inclusion criteria were determined as the presence of substantial deficit and disability caused by HIE. Wharton’s jelly-derived mesenchymal stem cells (WJ-MSCs) were intrathecally (IT), intramuscularly (IM), and intravenously administered to participants at a dose of 1 × 106/kg for each administration route twice monthly for 2 mo. In different follow-up durations, the effect of WJ-MSCs administration on HIE, the quality of life, prognosis of patients, and side effects were investigated, and patients were evaluated for neurological, cognitive functions, and spasticity using the Wee Functional Independence Measure (Wee FIM) Scale and Modified Ashworth (MA) Scale. Results For all participants (n = 6), the mean duration of exposure to hypoxia was 39.17 + 18.82 min, the mean time interval after HIE was 21.83 ± 26.60 mo, the mean baseline Wee FIM scale score was 13.5 ± 0.55, and the mean baseline MA scale score was 35 ± 9.08. Three patients developed only early complications such as low-grade fever, mild headache associated with IT injection, and muscle pain associated with IM injection, all of which were transient and disappeared within 24 h. The treatment was evaluated to be safe and effective as demonstrated by magnetic resonance imaging examinations, electroencephalographies, laboratory tests, and neurological and functional scores of patients. Patients exhibited significant improvements in all neurological functions through a 12-mo follow-up. The mean Wee FIM scale score of participants increased from 13.5 ± 0.55 to 15.17 ± 1.6 points (mean ± SD) at 1 mo (z = - 1.826, P = 0.068) and to 23.5 ± 3.39 points at 12 mo (z = -2.207, P = 0.027) post-treatment. The percentage of patients who achieved an excellent functional improvement (Wee FIM scale total score = 126) increased from 10.71% (at baseline) to 12.03% at 1 mo and to 18.65% at 12 mo posttreatment. Conclusion Both the triple-route and multiple WJ-MSC implantations were safe and effective in pediatric patients with HIE with significant neurological and functional improvements. The results of this study support conducting further randomized, placebo-controlled studies on this treatment in the pediatric population.Öğe Phase I study on the safety and preliminary efficacy of allogeneic mesenchymal stem cells in hypoxic-ischemic encephalopathy(Baishideng Publishing Group Co, 2021) Kabataş, Serdar; Civelek, Erdinç; Kaplan, Necati; Savrunlu, Eyüp Can; Sezen, Gülseli Berivan; Chasan, Mourat; Can, Halil; Genç, Ali; Akyuva, Yener; Boyalı, Osman; Diren, Furkan; Karaöz, ErdalBACKGROUND Hypoxic-ischemic encephalopathy (HIE) is a leading cause of morbidity and mortality in the adult as well as in the neonate, with limited options for treatment and significant dysfunctionality. AIM To investigate the safety and preliminary efficacy of allogeneic mesenchymal stem cells (MSCs) in HIE patients. METHODS Patients who had HIE for at least 6 mo along with significant dysfunction and disability were included. All patients were given Wharton's jelly-derived MSCs at 1 × 106/kg intrathecally, intravenously, and intramuscularly twice a month for two months. The therapeutic effects and prognostic implications of MSCs were evaluated by multiple follow-ups. Functional independence measure (FIM), modified Ashworth, and Karnofsky scales were used to assess any side effects, neurological and cognitive functions, and overall outcomes. RESULTS The 8 subjects included in the study had a mean age of 33.25 ± 10.18 years. Mean HIE exposure and mean post-HIE durations were 45.63 ± 10.18 and 19.67 ± 29.04 mo, respectively. Mean FIM score was 18.38 ± 1.06, mean modified Ashworth score was 43.5 ± 4.63, and mean Karnofsky score was 20. For the first 24 h, 5 of the patients experienced a subfebrile state, accompanied by mild headaches due to intrathecally administration and muscle pain because of intramuscularly administration. Neurological and functional examinations, laboratory tests, electroencephalography, and magnetic resonance imaging were performed to assess safety of treatment. Mean FIM score increased by 20.88 ± 3.31 in the first month (P = 0.027) and by 31.38 ± 14.69 in 12 mo (P = 0.012). The rate of patients with an FIM score of 126 increased from 14.58% to 16.57% in the first month and 24.90% in 12 mo. CONCLUSION Multiple triple-route Wharton's jelly-derived MSC administrations were found to be safe for HIE patients, indicating neurological and functional improvement. Based on the findings obtained here, further randomized and placebo research could be performed.Öğe Supin ve pron pozisyonlarda seri manyetik rezonans görüntüleme ile konus medullaris hareket aralığının analizi: 40 ardışık sağlıklı insan denekle elde edilen sonuçlar(Istanbul Univ, Faculty Medicine, Publishing Office, 2019) Gömleksiz, Cengiz; Can, Halil; Yaka, Umut; Göker, Burcu; Aydöşeli, Aydın; Barburoğlu, Mehmet; Sencer, Altay; Özgen, Utku; Sencer, Serra; Yörükoğlu, Ali Güven; Kırış, TalatAmaç: Bu çalışmada seri halde supin ve pron pozisyonlarda T1 ve T2 ağırlıklı aksiyal ve sagital manyetik rezonans görüntüleme yapılan 40 sağlıklı insanda meduller konusun supin-pron pozisyon değişikliği ile uyarılan hareket aralığı değerlendirildi. Yöntem: Her bir denekte konus medullarisin ucu seviyesinde elektronik ölçekler kullanılarak konus medullaris ve ön dural yüzey arasındaki mesafeyi ve dural kesenin genişliğini ölçtük. Elde edilen veriler SPSS 15 kullanılarak değerlendirildi. Bulgular: Konus ucunun, denekler supin pozisyondan pron pozisyona getirildiğinde ortalama değer olarak spinal kanal genişliğinin %30±14’ü oranında yer değiştirdiği saptandı (p:0,0001). Yaş (0-18 ve >19 yaş) ve cinsiyet farklılığı konus ucunun hareketliliğinde istatistiksel olarak anlamlı faktörler değildi. Sonuç: Çalışmamız klinik olarak gergin omurilik şüphesi bulunan normal uzanımlı konus vakalarında güvenilir bir diyagnostik referans aralığı sunmaktadır.Öğe Torakolomber bileşke disk herniasyonlarının cerrahi tedavisinde posterolateral transkambin yaklaşım(Istanbul Univ, Fac Medicine, Publ Off, 2020) Can, Halil; Diren, FurkanAmaç: Torakolomber bileşke disk herniasyonlarının (TLBDH) tedavisi için optimal cerrahi yaklaşım biçimi halen tartışmalıdır. TLBDH’nın güncel cerrahi tedavisinde anterolateral retroperitoneal, anterior transtorasik, posterolateral, lateral ve transforaminal endoskopik yaklaşımlar uygulanmaktadır. Posterolateral transkambin yaklaşımda, pars interartikülaris ve faset ekleminden minimal kemik alınarak, instabiliteye yol açmadan diskektomi ile dekompresyon sağlanmaktadır. Transkambin yaklaşımın, ileri düzeyde nöral doku retraksiyonu olmaksızın diskektomi yapılabilmesi, iyileşme süresinin kısa olması ve postoperatif komplikasyonların daha az görülmesi gibi avantajları vardır. Yöntemler: Kliniğimizde 2016-2018 tarihleri arasında posterolateral transkambin yaklaşım ile ameliyat edilen 3’ü T12-L1 ve 5’i L1-2 TLBDH’lı 8 hasta retrospektif olarak sunuldu. Çalışmamıza far lateral, foraminal ve paramedian uzanım gösteren, klinik olarak kauda ekuina sendromu, konus medüllaris sendromu ve radikülopatiye neden olmuş, ekstrüde veya sekestre disk hernili hastalar dahil edildi. Hastalarda cilt insizyonu ve fasyanın açılışı orta hattan yapıldı. Paravertebral adeleler subperiostal sıyrılarak pars lateralinde çıkan kök açığa konulup sekestre veya ekstrüde disk fragmanlarının alınması hedeflendi. Bulgular: Hastaların 3’ü erkek, 5’i kadın ve ortalama yaşı 45,1 (32- 66) olarak saptandı. Ortalama operasyon süresi 57,8 dakikaydı. Preoperatif VAS değerleri 8,75±0,51, postoperatif VAS değerleri 1,25±0,65 saptandı. MacNab klasifikasyonuna göre postoperatif 6 ay sonraki sonuçları; %62,5‘i mükemmel, %25’i iyi, %12,5’i vasat olarak bulundu. Hastalarda nörolojik hasar, beyin omurilik sıvısı (BOS) fistülü, pnömotoraks ve operasyon lojunda hematom gelişmedi.
