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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 Effect of visible light on vasospasticity of post-subarachnoid hemorrhage cerebrospinal fluid(Thieme Medical Publ Inc, 2017) Sabancı, Pulat Akın; Omay, Bülent; Aras, Yavuz; Aydöşeli, Aydın; Ali, Ahmet; Erdem, Tülin; Sencer, Altay; Kırış, TalatBackground and Objective Cerebral vasospasm (CV) is a serious complication of subarachnoid hemorrhage (SAH) with high morbidity and mortality rates. The mechanism of CV has not been determined. There are many theories related to this unsolved issue, one of which supports CV as a two-stage phenomenon from a pathophysiologic perspective. The first stage consists of inhibition of neuronal nitric oxide synthase by oxyhemoglobin, which results in a decrease of nitric oxide (NO) production. The second stage consists of an increase in the levels of asymmetric dimethylarginine through bilirubin oxidation products (BOXes), which are oxidized by-products of hemoglobin metabolism. These in turn inhibit endothelial nitric oxide synthase (eNOS), which results in the blockage of the second NO production mechanism. BOXes are sensitive to visible light, as is their precursor bilirubin. The hypothesis of CV prevention using the photosensitivity of BOXes was tested in this study. Material and Methods Cerebrospinal fluid (CSF) obtained from two patients with SAH was divided in half and either exposed to a standard dose of visible light or not exposed to any light. The CSF was spectrophotometrically investigated and the concentration of BOXes was measured. A comparison between CSF samples exposed to light and not exposed to light was made. Using two groups of 16 rats each, the vasospastic effect of the CSF exposed and not exposed to light on arteries of the cortical surface was measured. The cortex was exposed using the cranial window. Results Spectrophotometric analysis revealed that the concentration of BOXes in the CSF decreased significantly after being exposed to visible light ( p <0.001). There was a significant difference of the vasospastic effect of CSF on exposed cortical arteries ( p <0.001). Conclusion The concentration of BOXes and the vasospastic effect of CSF taken from patients with SAH were significantly reduced after being exposed to visible light if compared with CSF not exposed to light.Öğe Fully endoscopic interlaminar and transforaminal lumbar discectomy: analysis of 47 complications encountered in a series of 835 patients(Elsevier Espana Slu, 2017) Yörükoğlu, Ali Güven; Göker, Burcu; Tahta, Alican; Akçakaya, Mehmet Osman; Aydoseli, Aydın; Sabancı, Pulat Akın; Aras, Yavuz; Alkır, Görkem; Sencer, Altay; Imer, Murat; İzgi, Nail; Canbolat, Ali TuncayObjective: To report perioperative complications in fully endoscopic lumbar discectomy (FELD). Methods: From September 2010 to November 2016, 835 patients underwent FELD. In total, 865 disc levels were operated on. Of the 835 patients, the transforaminal (TF) approach was used in 174 patients, while 691 patients were operated on using the interlaminar (IL) approach. Surgical complications occurred in 47 patients, which were retrospectively analyzed. Results: Neurological deficits occurred in six patients. In four of these six patients, deficits resolved spontaneously. In one patient, symptoms resolved after a laminectomy procedure. In only one case, the neurological deficit was permanent. Seven patients complained of dysesthesia, which resolved spontaneously with medical treatment in four patients. In the remaining two patients, dysesthesia symptoms improved after epidural and foraminal injections. Dural tears were encountered in 26 patients. Pudendal neuralgia occurred in three patients. 'Itvo cases showed wound infection. The other complications comprised one disc infection, one retroperitoneal hematoma and one wrong level surgery. Conclusion: The FELD procedure has a steep learning curve and it is a difficult procedure to master. Surgeons should be aware of complications that can occur with the FELD procedure, most of which resolve spontaneously. (C) 2017 Sociedad Espanola de Neurocirugia. Published by Elsevier Espana, S.L.U. All rights reserved.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.
