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Öğe Allogeneic mesenchymal stem cells may be a viable treatment modality in cerebral palsy(Baishideng Publishing Group Inc, 2024) Boyali, Osman; Kabatas, Serdar; Civelek, Erdinc; Ozdemir, Omer; Bahar-Ozdemir, Yeliz; Kaplan, Necati; Savrunlu, Eyup CanBACKGROUND Cerebral palsy (CP) describes a group of disorders affecting movement, balance, and posture. Disturbances in motor functions constitute the main body of CP symptoms. These symptoms surface in early childhood and patients are affected for the rest of their lives. Currently, treatment involves various pharmacotherapies for different types of CP, including antiepileptics for epilepsy and Botox A for focal spasticity. However, none of these methods can provide full symptom relief. This has prompted researchers to look for new treatment modalities, one of which is mesenchymal stem cell therapy (MSCT). Despite being a promising tool and offering a wide array of possibilities, mesenchymal stem cells (MSCs) still need to be investigated for their efficacy and safety. AIM To analyze the efficacy and safety of MSCT in CP patients. METHODS Our sample consists of four CP patients who cannot stand or walk without external support. All of these cases received allogeneic MSCT six times as 1 x 10(6)/kg intrathecally, intravenously, and intramuscularly using umbilical cord-derived MSCs (UC-MSC). We monitored and assessed the patients pre- and post-treatment using the Wee Functional Independence Measure (WeeFIM), Gross Motor Function Classification System (GMFCS), and Manual Ability Classification Scale (MACS) instruments. We utilized the Modified Ashworth Scale (MAS) to measure spasticity. RESULTS We found significant improvements in MAS scores after the intervention on both sides. Two months: Right chi(2) = 4000, P = 0.046, left chi(2) = 4000, P = 0.046; four months: Right chi(2 )= 4000, P = 0.046, left chi(2) = 4000, P = 0.046; 12 months: Right chi(2) = 4000, P = 0.046, left chi(2) = 4000, P = 0.046. However, there was no significant difference in motor functions based on WeeFIM results (P > 0.05). GMFCS and MACS scores differed significantly at 12 months after the intervention (P = 0.046, P = 0.046). Finally, there was no significant change in cognitive functions (P > 0.05). CONCLUSION In light of our findings, we believe that UC-MSC therapy has a positive effect on spasticity, and it partially improves motor functions.Öğe Clinical results of percutaneous vertebroplasty in thoracolumbar (T6- L5) vertebral compression fractures: retrospective study of 111 patients with 140 fractured segments(2019) Özger, Özkan; Kaplan, NecatiObject: Vertebroplasty was first applied by Harve Deramond to a patient with vertebral hemangioma in 1984. In recent years, the increase in the number of osteoporosis, trauma and tumor cases has increased the incidence of vertebral compression fractures (VCFs). Nowadays, percutaneous vertebroplasty (PVP) has been a widely used treatment for painful acute VCFs. It is a minimally invasive technique. In this procedure, polymethylmethacrylate (PMMA) is injected into the vertebral corpus. There are PMMA’s ability to increase stability at fracture site, thermal necrosis effect and chemotoxic effect on intra-osseous pain receptors. In this study, the safety and efficacy of PVP in patients with VCF were evaluated. Methods: The patients who underwent PVP under sedoanalgesia or general anesthesia for single or multi-level thoracolumbar vertebrae fracture were reviewed retrospectively between January 2012 and March 2018. The study included 111 patients with VCF. 140 vertebral levels were treated with PVP. These VCFs were evaluated in 3 groups as osteoporotic, traumatic and pathological. We used the Oswestry Disability Index (ODI) for functional disability and the Visual Analog Scale (VAS) for pain severity. Our patients were followed up for 12 month after PVP. Results: Patients mean age was 73,04 ± 7,17 years (91-56 years) and 18 (16,22 %) were male and 93 (83,78 %) were female. The most commonly affected vertebrae were T12 and L1 vertebrae corpus. Following PVP, VAS and ODI values decreased significantly in the last 12 months compared to preoperative levels (p<.001). Cement leakage was occurred in six patients (5.40 %). Conclusions: PVP is an advantageous method. Because the procedure is fast and easy, a biopsy can be taken during the procedure, patients can soon stand up and be discharged; its complications are much less than open surgery. In addition to general anesthesia, it can be performed with sedoanalgesia. It is a reliable and effective technique for the treatment of pain due to osteoporotic and traumatic VCFs or metastatic lesions.Öğe Effects of exosomes from mesenchymal stem cells on functional recovery of a patient with total radial nerve injury: A pilot study(Baishideng Publishing Group Inc, 2024) Civelek, Erdinc; Kabatas, Serdar; Savrunlu, Eyup Can; Diren, Furkan; Kaplan, Necati; Ofluoglu, Demet; Karaoz, ErdalBACKGROUND Peripheral nerve injury can result in significant clinical complications that have uncertain prognoses. Currently, there is a lack of effective pharmacological interventions for nerve damage, despite the existence of several small compounds, peptides, hormones, and growth factors that have been suggested as potential enhancers of neuron regeneration. Despite the objective of achieving full functional restoration by surgical intervention, the persistent challenge of inadequate functional recovery remains a significant concern in the context of peripheral nerve injuries. AIM To examine the impact of exosomes on the process of functional recovery following a complete radial nerve damage. METHODS A male individual, aged 24, who is right-hand dominant and an immigrant, arrived with an injury caused by a knife assault. The cut is located on the left arm, specifically below the elbow. The neurological examination and electrodiagnostic testing reveal evidence of left radial nerve damage. The sural autograft was utilized for repair, followed by the application of 1 mL of mesenchymal stem cell-derived exosome, comprising 5 billion microvesicles. This exosome was split into four equal volumes of 0.25 mL each and delivered microsurgically to both the proximal and distal stumps using the subepineural pathway. The patient was subjected to a period of 180 d during which they had neurological examination and electrodiagnostic testing. RESULTS The duration of the patient's follow-up period was 180 d. An increasing Tinel's sign and sensory-motor recovery were detected even at the 10(th) wk following nerve grafting. Upon the conclusion of the 6-mo post-treatment period, an evaluation was conducted to measure the extent of improvement in motor and sensory functions of the nerve. This assessment was based on the British Medical Research Council scale and the Mackinnon-Dellon scale. The results indicated that the level of improvement in motor function was classified as M5, denoting an excellent outcome. Additionally, the level of improvement in sensory function was classified as S3+, indicating a good outcome. It is noteworthy that these assessments were conducted in the absence of physical therapy. At the 10(th) wk post-injury, despite the persistence of substantial axonal damage, the nerve exhibited indications of nerve re-innervation as evidenced by control electromyography (EMG). In contrast to the preceding. EMG analysis revealed a significant electrophysiological enhancement in the EMG conducted at the 6(th)-mo follow-up, indicating ongoing regeneration. CONCLUSION Enhanced comprehension of the neurobiological ramifications associated with peripheral nerve damage, as well as the experimental and therapy approaches delineated in this investigation, holds the potential to catalyze future clinical progress.Öğe Epidemiological investigation of 673 patients who resorted to the emergency department for mild head trauma complaints(2019) Özger, Özkan; Kaplan, Necati; Karaaslan, NumanAim: Mild head trauma (MHT) or mild traumatic brain injury (MTBI) is an injury whose incidence is increasing in emergency services. This retrospective study carried out an epidemiological evaluation of patients with MHT, who underwent head computed tomography (HCT) with a 15-point score on the Glasgow Coma Scale (GCS). Material and Methods: This study retrospectively evaluated 673 patients with MHT, who were examined by the department of neurosurgery in the emergency department of Istinye University, Canakkale Anatolian Hospital between 2015 and 2019. The cases were evaluated because of age, gender, cause of trauma, HCT findings, duration of admission to the emergency department, and other body traumas associated with head trauma. Results:390 (57.95%) patients were male, while 283 (42.05%) were female. The mean age and standard deviation were calculated as 23.72 ± 24.87 years. Of the 673 cases, 494 (73.40%) were admitted to the emergency department due to non-high falls. After trauma, 642 (95.39%) patients were admitted to the emergency department within the admitted to the emergency department within the first two hours after injury. 656 (97.48%) of the patients were treated in the emergency department. 105 (15.60%) patients had a scalp incision and underwent a small surgical procedure. The most common accompanying body trauma detected was that of the maxillofacial region in 26 (3.86%) patients. HCT pathology was detected in 20 (2.97%) patients. These pathologies included; 14 (2.08%) non-surgical intracerebral hemorrhage, 2 (0.30%) skull base fractures, 1 (0.15%) traumatic subdural hematoma, 1 (0.15%) traumatic epidural hematoma, 1 (0.15%) pneumocephalus and 1 (0.15%) cerebral edema. Conclusion: Head trauma is an important issue in this country. Brain CT may not be necessary in patients with a GCS score of 15. After a short observation, if patients live near the medical center, they can be sent home to return the next day for further evaluation.Öğe Evaluation of clinical outcomes of 271 patients undergoing lumbar microdiscectomy in the light of literature(2020) Özger, Özkan; Kaplan, NecatiAim: Lumbar microdiscectomy (LMD) is considered as a gold standard surgical technique for the treatment of patients with lumbar disc hernia (LDH) although various types of treatment are being developed. This study aimed to investigate the safety and efficacy of LMD in our clinic. Material and Methods: The study exclusively included 271 patients undergoing LMD due to LDH. Preoperative and postoperative (10th day, 1st month, and long-term) Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared. Clinical outcomes were analyzed retrospectively based on modified Macnab criteria. Complications were noted. SPSS Statistics 22.0 software package was used to analyse the data for pre- and postoperative VAS and ODI scores. A p value of <0.05 was considered statistically significant. Results: The mean length of stay in the operating room and hospital was 165.04±36.99 min and 1642.02±574.90 min, respectively. There was a significant decrease in postoperative VAS and ODI (%) scores compared to preoperative scores. Preoperative VAS and postoperative long-term VAS scores were 8.99±0.62 and 1.38±0.95, respectively whereas preoperative ODI (%) and postoperative long-term ODI (%) scores were 85.33±6.74 and 12.96±9.58, respectively (p<0.001). The success rate for excellent or good outcomes according to the modified Macnab criteria was 87.45%. During surgery, cerebrospinal fluid (CSF) leak and dura defect developed in four patients (1.48%) and there was only dura defect in two patients (0.73%). After the surgery, recurrent LDH, spinal infection, and spinal epidural hematoma developed in seven (2.58%), three (1.11%), and one patient (0.37%), respectively. Conclusion: LMD is an effective and safe method in the treatment of LDH as it has low complication rates and high success ratesÖğe 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 Functional recovery after wharton's jelly-derived mesenchymal stem cell administration in a patient with traumatic brain injury: a pilot study(TURKISH NEUROSURGICAL SOC, 2020) Kabataş, Serdar; Civelek, Erdinç; Sezen, Gülseli Berivan; Kaplan, Necati; Savrunlu, Eyüp Can; Çetin, Ercan; Diren, Furkan; Karaöz, ErdalAIM: To introduce a traumatic brain injury (TBI) patient who underwent stem cell transplantation (SCT) in order to minimize the remaining injury deficiencies. MATERIAL and METHODS: This study included a 29 years old male who had TBI resulting from a vehicle accident which took place one and a half years ago. The participant received six doses of intrathecal, intramuscular, and intravenous transplantation of Wharton's jelly-derived mesenchymal stem cells (WJ-MSCs) at a goal dose of 1 x10(6) / kg respectively for each route of administration for six months. RESULTS: No important negative effects were reported. The patients' speech, cognitive, memory and fine motor skills were improved. The efficacy of treatment with SCT was assessed with cranial magnetic resonance imaging (MRI), computed tomography (CT) screening, and electroencephalography (EEG). CONCLUSION: SCT can have a promising future as a medical approach in recurrent TBI.Öğe Functional recovery after wharton’s jelly–derived mesenchymal stem cell administration in a patient with traumatic spinal cord injury: a pilot study(Gelenos, 2021) Kabataş, Serdar; Civelek, Erdinç; Savrunlu, Eyüp Can; Kaplan, Necati; Çetin, Ercan; Diren, Furkan; Boyali, Osman; Güven, Göksel; Karaöz, ErdalThe use of stem cells in the treatment of traumatic spinal cord injury (SCI) in recent years has provided promising results. Different sources of cells for transplantation have been used, including mesenchymal stem cells [MSCs; e.g., Wharton’s jelly-derived (MSCs WJ-MSCs)]. Here, we reported on a 29-year-old man who was treated with WJ-MSCs in the course of therapy for blunt, traumatic SCI due to a work accident. He was operated on within 6 hours of the injury. Three and a half months later, he underwent intrathecal, intramuscular, and intravenous administrations of WJ-MSCs at a target dose of 1x106/kg for each application route (twice a month for 2 months). All the procedures were tolerated well by the patient. In parallel to this, we have not seen any application-related complications so far. After stem cell infusions, progressive improvements were shown in the patient’s neurological examination and neurophysiological and neuroradiological findings.Öğe Hydrocephalus following surgery of thoracic intradural arachnoid cyst: a case report(Turkish Neurosurgical Soc, 2020) Özger, Özkan; Kaplan, NecatiSpinal intradural arachnoid cysts (SIACs) are cerebrospinal fluid (CSF) sacs formed by arachnoid membranes. They may be idiopathic or acquired. Treatment is resection, fenestration, or cyst drainage. A 41-year-old female patient presented with myelopathy symptoms and complaints. Magnetic resonance imaging (MRI) revealed a T6-T10 dorsal intradural arachnoid cyst. A T6-T10 laminectomy was performed and an arachnoid cyst was excised under surgical microscope. The cyst contained a clear liquid that was surrounded by a transparent membrane. At 7 weeks postoperatively, the patient experienced severe headache, excessive sleepiness, vomiting, loss of coordination, difficulty walking, and difficulty concentrating. A head computed tomography (CT) scan showed marked ventricular dilation that was diagnosed as delayed hydrocephalus. The patient underwent ventriculoperitoneal shunt (VPS) placement one day after admission. This is a rare condition of hydrocephalus that develops due to CSF leakage after SIAC surgery.Öğe Incidence of early postoperative ischemic stroke in lumbar discectomy: a retrospective study(2020) Özger, Özkan; Kaplan, NecatiAim: Ischemic stroke (IS) is one of the leading causes of death worldwide. It may cause undesirable neurological sequels. This study aims to determine the incidence of IS in the early postoperative period in patients operated for lumbar disc herniation. Material and Methods: The electronic medical records of patients who underwent elective lumbar disc herniation surgery between January 2017 and August 2019 were reviewed retrospectively. Patients with preoperative infection and neoplastic disease were excluded from the study. Patient demographics, pre and postoperative pain and disability levels, operated disc levels, duration of surgery and hospital stay, and complications were recorded. Results: Of the 179 patients who underwent lumbar microdiscectomy for lumbar disc herniation, a total patient of one (0.55%) patient developed IS in the right cerebellar region in the early postoperative period. The risk factors detected in the patient included hypertension, carotid artery stenosis and therefore irregular use of acetylsalicylic acid. Postoperative infection was detected in two patients (1.12%), peroperative cerebrospinal fluid leak in two patients (1.12%), and recurrent lumbar disc herniation in three patients (1.67%) in the late period. No mortality was observed. Conclusion: In recent years, there has been an increase in minimally invasive spine surgeries, especially in elderly patients at risk of ischemic stroke. It is important to identify and optimize these patients before surgery. While the incidence of ischemic stroke following lumbar microdiscectomy is low, it is necessary to be careful as a high risk of morbidity and mortality is in question.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 Should we perform routine biopsy during percutaneous vertebroplasty in vertebral compression fractures?(2019) Özger, Özkan; Kaplan, NecatiObjective: Percutaneous vertebroplasty (PVP) is widely used all over the world, especially in elderly patients for osteoporotic, traumatic, and pathological vertebral compression fractures (VCFs). Previous studies have reported incidental tumors in vertebral biopsy. However, whether a routine biopsy should be performed during PVP is controversial. The aim of this study was to evaluate the importance of routine biopsy during PVP in the treatment of VCF. Materials and Methods: The patients who underwent PVP under sedo-analgesia for single or multi-level thoracolumbar vertebrae fracture were reviewed retrospectively between March 2015 and June 2019. The study included 87 patients with VCF. A hundred eleven vertebral levels were treated with PVP. Vertebral bone biopsy was performed in 67 (77.01%) patients. These biopsy specimens were examined pathologically. The mean age of the patients was 74.18±9.08 years (91-48 years), and 12 of them (17.91%) were male and 55 (82.09%) were female. Results: Malignancy was detected in 3 patients (4.48%). Two of them were multiple myeloma and the other one was renal cell carcinoma metastasis. Conclusion: Bone biopsy during PVP procedures does not cause significant time loss or complications. Therefore, revealing the underlying pathology provides a great advantage to the patient and the surgeon. We recommend routine vertebral bone biopsy using a biopsy needle during the PVP procedure.Öğe Spontaneous spinal epidural hematoma following warfarin treatment: case report(2020) Özger, Özkan; Kaplan, NecatiSpontaneous spinal epidural hematoma (SSEH) is a rare but clinically important disease, and delayed diagnosis may have serious consequences. When a patient presents to the emergency department with sudden, unexplained neck, back or low back pain during anticoagulant therapy, the possibility of SSEH should be considered. Magnetic resonance imaging (MRI) is important for early diagnosis of SSEH. In this article, we present a rare case of SSEH in the thoracolumbar region due to warfarin treatment in a 53-year-old woman and compare her clinical features and treatment approach with similar patients in the literature. The patient was admitted to the emergency department with severe back pain and paraparesis. She was using warfarin as a part of anticoagulant therapy following a coronary bypass. Her blood test results showed that the international normalised ratio was 4.13. Spinal MRI revealed an SSEH extending between T11 and L1 levels and compressing the spinal cord. The hematoma was evacuated by surgery 1 day after the preoperative preparations. The patient was mobilised on the fifth postoperative day. On the 40th postoperative day, she visited the outpatient clinic with a full recovery. In the literature, SSEH is usually presented in case reports and warfarin-induced SSEH is a very rare condition
