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  • Küçük Resim
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    Can the fracture line of type ii odontoid fractures come to a neutral position after anterior odontoid screw fixation without a manipulation?
    (Turkish Neurosurgery Society, 2022) Kuytu, Turgut; Karaoğlu, Ahmet; Çelik, Mesut; Aydemir, Fatih; Özpar, Rıfat; Tüzün, Yusuf
    AIM: Anterior odontoid screw fixation (AOSF) is known as a safe and effective method in type II odontoid fractures but in displaced cases, it is recommended to turn the displaced fracture line into neutral position with post-anesthesia manipulation and to return to posterior technique in cases where this is not possible. The aim of the study was to examine whether there was an improvement in the displaced fracture line in the follow-up, in which AOSF was performed without manipulation and to determine the “displacement angle range” in which AOSF was possible. MATERIAL and METHODS: 11 patients with the diagnosis of type II odontoid fracture who underwent AOSF without manipulation were analyzed retrospectively. A control group of 30 cases was formed and odontoid related angle measurements were performed on cervical computed tomographies (CT) of the control group and the patients who were operated. RESULTS: In 6 of 7 cases in the posterior-displaced group along with all cases in the anterior-displaced group, it was determined that the displacement angles returned to the normal range in the 1st year follow-up. In 1 case having posterior displacement with posterior longitudinal ligament (PLL) damage, it was observed that the displacement angle improved to the normal range significantly, but the displacement continued. CONCLUSION: AOSF is a minimally invasive, safe and effective method in patients with displaced type II odontoid fracture, which is between the median odontoidobasal angle range of 100°-134°, whose PLL is preserved, and which cannot be manipulated.
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    Hemorrhagic presentation of previously silent brain tumors
    (Neurocirugia, 2022) Türkkan, Alper; Khezri, Marzieh Karimi; Eser, Pınar; Kuytu, Turgut; Tolunay, Şahsine; Bekar, Ahmet
    Introduction and objectives: Acute presentation with intracranial hemorrhage owing to a previously silent brain tumor (BT) is rare. Although any BT can bleed, the frequency and type of bleeding varies across tumor types. Materials and methods: We aimed to retrospectively review our experience with 55 patients with BTs presenting with ICH. Results: Signs of increased intracranial pressure were the most common symptoms. The temporal lobe was the most common lesion site (n = 22). Hemorrhages were mainly confined to the tumor margins (HCTs) (n = 34). Extensive intraparenchymal hemorrhages (EIHs) were mainly associated with moderately/severely decreased levels of consciousness (LOCs) (n = 15/16). High-grade glioma (HGGT) (n = 25) was the leading pathological diagnosis followed by metastasis (MBT) (n = 16/55). The hemorrhage type was associated with the pathological diagnosis of the tumor. Patients with HGGT (n = 19/25) and MBT (n = 9/16) mainly presented with HCTs, whereas low-grade gliomas (LGGT) primarily caused EIHs (n = 6/7). Conclusions: Hemorrhagic presentation is a rare occurrence in BTs. Among all, MBT and HGGT are responsible for majority of the cases. Importantly, despite their relatively benign characteristics, LGGTs mainly result in extensive parenchymal destruction once they bleed. Maximum surgical resection of hemorrhagic BTs and decompression of the affected brain regions followed by histological confirmation of the diagnosis should be the main goals of treatment in cases with hemorrhagic BTs
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    Variations of perforating arteries of anterior communicating artery in cases with anterior communicating artery aneurysms: a cadaveric anatomical study
    (Springer, 2022) Kuytu, Turgut; Kocaeli, Hasan; Korfalı, Ender
    Purpose In terms of postoperative morbidity and mortality, preservation of the perforating arteries branching from the anterior communicating artery (ACoA) during clipping is particularly imperative in patients with ACoA aneurysm. In the present study, we aimed to investigate whether perforating arteries originated from ACoA were pushed away in a diferent location in patients with ACoA aneurysm. Furthermore, if they did so, we aimed to identify the direction in which they were dislocated and how the perforating arteries could be preserved during clipping. Methods Herein, we categorized 40 brains obtained from cadavers into two groups. The frst (n=26) and second (n=14) groups included cases without and with ACoA aneurysms, respectively. After completing the preparation procedure, the brains were dissected using surgical microscope and the relevant anatomical region was examined and photographed. Finally, statistical analyses were performed on the data and the results were documented. Results In the aneurysms with posterior and superior projections, the perforators appeared to be pushed away inferiorly and were frequently noted at the anteroinferior part of the aneurysm neck. Most of the cases, where one of the A1s was larger at one side, the perforating arteries arose from the larger A1 side. Conclusion The mortality and morbidity associated with damage to the perforators can be reduced by approaching the patient from the dominant A1 side and pursuing the perforators primarily at the anteroinferior part of the aneurysm neck in the aneurysms with superior and posterior projections.