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Although radiological methods are sufficient for the diagnosis of spontaneous subarachnoid hemorrhage (SAH), additional biomarkers are needed to predict prognosis. The aim of this study was to investigate the effects of serum S100B protein, Glial Fibrillary Acidic Protein (GFAP) levels and, Optic Nerve Sheath Diameter (ONSD) on mortality and clinical severity in patients with spontaneous SAH.Fifty-six patients who were diagnosed with SAH after first evaluation in the emergency department (ED) were included in the study group; Forty-six patients who were admitted to the ED with headache of non-intracranial etiology, were included as the control group. Cerebral computed tomography (CT) images and peripheral blood samples were obtained from all patients; at the time of diagnosis and 24 h after diagnosis. Serum S100B protein and GFAP levels were measured from the blood samples and ONSD was measured on CT.Serum S100B protein and GFAP levels and, ONSDs at the time of diagnosis and 24 h after diagnosis were significantly higher in the study group (p 0.05). Both GFAP levels and ONSD at the time of diagnosis and 24 h after the diagnosis were found to be related with increased mortality (p 0.05). A similar association was found for serum S100B protein levels 24 h after the diagnosis, but not at the time of diagnosis (p = 0.540).Serum S100B protein and GFAP levels and, ONSD were increased in patients with spontaneous SAH. All parameters were found to be associated with increased mortality.

OBJECTIVE: The current study was planned to investigate the relationship of serum level of pentraxine-3 with various clinical and neurological scales and scores. METHODS: The prospective case-control study was conducted at the Emergency Department of the Ondokuz Mayis University, Samsun, Turkey, from March 2013 to June 2014, and comprised subarachnoid haemorrhage patients and healthy. Pentraxine-3levels were measured from serum samples and compared with sub-groups of the various scales and scores used in the study. Data was analysed using SPSS 15. RESULTS: Of the 77 subjects, 40(52%) were patients and 37(48%) were controls. Pentraxine-3levels in the cases were significantly higher than the controls (p

Aslan, Serdar/0000-0003-2950-8767; Aslan, Serdar/0000-0003-2950-8767 WOS: 000414144400022 PubMed: 28730314 Cerebral cortical venous aneurysm also known as cerebral varix is a rare entity that usually occurs in relation to high-flow draining veins of arteriovenous fistulas, arteriovenous malformations, and venous angioma. Isolated cerebral varix is an extremely rare entity. We present a 1-year-old male with isolated cerebral varix. During follow-up, the varix thrombosed spontaneously without causing any neurological deficits. To the best of our knowledge, spontaneous asymptomatic thrombosis of an isolated cerebral varix without any clinical finding was reported for the first time in the literature.

BAYDIN, AHMET/0000-0003-4987-0878 WOS: 000281528200010 Spontaneous spinal epidural haematoma (SSEH) is a neurosurgical emergency that requires early diagnosis and treatment. An 88-year-old man presented to the emergency department with complaints of weakness in the legs, walking deficit, incontinence and back pain for the last two days. He had been on warfarin therapy for 5 years for atrial fibrillation. There was no antecedent trauma. The neurological examination revealed hypoesthesia below the T6 level, anaesthesia below the T10 level and complete paraplegia of both lower extremities. The INR level was 7.81 on admission. Magnetic resonance imaging revealed a posterolateral epidural haematoma extending from T2 to L5. He was given fresh frozen plasma and vitamin K in the emergency department. Emergency thoracic and lumbar laminectomy was performed by neurosurgeons. The probability of SSEH should be investigated in any patient under anticoagulation therapy who presents with signs of spinal compression in the emergency department. (Hong Kong j.emerg.med. 2010;17:367-371)

Objective:Acute subdural hematomas (ASDH) are severe traumatic brain injuries. Older patients have a higher mortality rate.We retrospectively reviewed 19 geriatric patients with ASDH to demonstrate the outcome of the management of ASDH and to find out which parameters are significant in predicting the outcome. Methods:Computer records and patient files of 19 geriatric patients with traumatic ASDH who underwent surgical intervention in OndokuzMayis University School of Medicine at Department of Neurosurgery between January 2006-December 2009 were reviewed.The diagnosis was based on computerized tomography (CT) findings.Examined criteria were age, sex , mechanism of the trauma, Glasgow Coma Score (GCS )on admission , presence of a midline shift and contusio cerebri , thickness of the haematoma , accompanying chronic diseases , anticoagulant therapy , type of surgery and neurological examination on discharge.ASDH of the posterior fossa , subacute-chronic subdural haematomas , patients with serious extracranial injuries and aged below 65 were excluded. Results:A GCS of ≤ 8 on initial presentation,pupillary non reactivity,presence of a midline shift and contusio cerebri was found to be significantly associated with increased mortality and a poor patient outcome.Effect of sex,anticoagulant therapy and type of surgery couldn’t have been found to be determinant on prognosis.

Kaplan, Suleyman/0000-0003-1477-5002 WOS: 000240916200003 PubMed: 16921453 Objective: The aim of this experimental study was to create a new focal venous infarction model in rats. Method: 20-male Sprague-Dawley rats were used in this experiment. Unilateral frontal strip craniectomy was done in front of the coronal suture. Frontal veins were observed by using the operative microscope. in this study we used the bipolar coagulation method over the transparent dura mater for occlusion of the bridging veins for venous infarction. Specimens were evaluated by histopathological techniques. Results: Unilateral frontal hemispheric swelling, midline shift, brain edema, subcortical petechial hemorrhage, hemorrhagic infarction and necrosis were the histopathological findings on microscopic examination. Conclusion: Our results revealed that the bipolar coagulation method over the transparent dura mater for occlusion of the unilateral frontal cortical veins for venous infarction might be a new experimental model in the evaluation of brain damage after disturbance to the venous circulation.

The present study investigated the benefits of intraoperative ultrasonographic guidance during the surgical repair of congenital cystic spinal dysraphic lesions. Twenty-one children with cystic spinal dysraphism who underwent surgical repair were examined by real-time ultrasonography during the surgical intervention. Five children had meningoceles, six had myelomeningoceles, four had open neural plaques, three had lipomyelomeningoceles, and three had diastematomyelia. Visualization of the cystic compartments, identification of the neural structures, and identification and localization of the associated lesions were all reliably achieved in all cases. Intraoperative ultrasonographic guidance could determine the type of lesion and the associated lipomas, ectopic tissues, dermoid and epidermoid cysts, and doubling of the spinal cord, and locate diastematomyelic spurs, bands, and adhesions. Components filled with cerebrospinal fluid appeared as anechoic areas, and lipomas as hyperechoic. Intraoperative ultrasonographic guidance allowed the surgeon to correlate the complex anatomy identified on preoperative computed tomography and magnetic resonance imaging to the surgical site during the operation. Better orientation to the defect allows appropriate repair of the lesion with optimal preservation of neural tissues.

ALTUN, Adnan/0000-0002-1328-6349 WOS: 000315308600003 PubMed: 23438657 Conventional biplanar fluoroscopic imaging of the cervical spine is commonly used during cervical spinal surgery. We designed an intraoperative traction device to prevent shoulder superimposition on the cervical fluoroscopic imaging. During surgery at the stage of fluoroscopic examination, an operator can apply traction via the traction band of the device. This device is safe and easy to use, and can be preoperatively fitted to patients. Fluoroscopic images obtained with the new traction device were definitely superior compared with images obtained without the traction device. This device may be useful in cases with difficult fluoroscopic imagination of the lower cervical spine.

Cartilaginous lines at the time of postnatal period in the C2 bone may be used for the dividing of C2 vertebra in the classification of C2 fractures. According to this classification, axis (C2) fractures are classified into three main groups based on a postnatal developmental model of C2. Eighteen cases of C2 fractures are classified according to this classification. They were divided into three main groups as the odontoid fractures, body fractures and neural arch fractures. Five patients had odontoid process fractures, 5 had body fractures, 2 had pedicle fractures, and 6 had neural arch fractures. Neural arch fractures consist of pars interarticularis fractures (3 cases) and others (3 cases with combined lamina and spinous process fractures). This classification is based mainly on the location of the fracture in the portion of the postnatal developmental segments. We suggest the use of a classification based on a postnatal development model. The use of this model can make classification of C2 fractures more systematic and more understandable.

WOS: 000245192900012 PubMed: 17323267 Brain protection is extremely important during arachnoidal dissection and brain separation with a metallic retractor to create a surgical corridor. We have designed a new type of paddy containing air-filled micro-balloons and cotton for use between the metallic retractor and the brain surface for maximal protection of the neuronal tissues from the pressure of the retractor. In neurosurgical operations, cotton paddies are commonly and generally used during the retraction of brain tissue. We hypothesized that air-filled micro-balloon paddies covered with cotton could be helpful in the gentle separation of brain tissue with metallic retractors for minimizing cerebral damage, and for separating sulcal and cisternal walls during brain operations. These paddies are 2 cm in width and 4 cm in length. Multiple air-filled silicon micro-balloons are located in a sheet with 1-2 mm separation from each other. These silicon micro-balloonoid sheets are covered with a cotton sheath. The thickness of this type of paddy is 2-3 mm from the anterior surface to the posterior surface. We used paddies in 86 brain operations where brain retraction was necessary to create a surgical corridor. There was no complication or unwanted events related with the use of these paddies. In conclusion: air-filled silicon micro-balloon,paddies are useful materials for the gentle separation of brain tissue with a metallic retractor in order to minimize cerebral damage, and for the separation of sulcal and cisternal walls during the surgical intervention.

Camlidag, Ilkay/0000-0001-6151-1312; ALTUN, Adnan/0000-0002-1328-6349 WOS: 000305206600003 PubMed: 22664993 AIM:The objective of this study was to introduce a surgical navigation method which provides a safe, quick and effective access to cortical and subcortical tumors, along with a review of other methods in use for this purpose. MATERIAL and METHODS: 53 patients have been operated using this technique. The area overlying the tumor is shaved and one half of a smoothly cut hazelnut is taped on the skin. The precise localization of the hazelnut is confirmed with MRI and then stained. After general anesthesia, the stained impression is projected firstly to the bone, dura and then cortex respectively by the Midas Rex cutting tip. Cortical landmarks surrounding the tumor's cortical projection are further confirmed with ultrasonography. RESULTS: After removal, cortical and subcortical tumors were separately graded for efficiency. Grade 1 and 2 were accepted as precise access. Our method accordingly yielded 95.2% and 90.6% success rates for cortical and subcortical tumors respectively. CONCLUSION: Considering the method's success rate along with its inexpensiveness and modest technical requirements, it is believed that this method can be of widespread use.

The hand holding devices are generally used during the course of micro-surgical operations in neurosurgery to prevent hand tremor. Recently we designed a new instrument for holding two arms. This instrument used for stabilization of two arms especially during microsurgical operations. We used this instrument in different type of operations such as aneurysm surgery, brain tumor surgery, hypophysis surgery, pontocerebellar tumor surgery and posterior fossa surgery. The ability of the instrument in the preventing of arm tremor, and comfort of the arm during surgery was graded as bad, good and excellent in terms of the description of surgeon during microsurgical operations. This instrument was used during 20 neurosurgical operations. The capability of the instrument during microsurgical operation was found as excellent in 65% of the operations. The capability was found as good in 35% of the operation. In conclusion; this instrument holds two arms in the same time and provide unrelated moving from each others. The capability of this instrument is high in the preventing of hand tremor. This instrument may be used during microsurgical operations in neurosurgery. J. Exp. Clin. Med., 2011; 28:111-116

keskin, ilknur/0000-0002-7059-1884; OZYASAR, ALI FARUK/0000-0002-5396-9486; Kaplan, Suleyman/0000-0003-1477-5002 WOS: 000296208400006 PubMed: 21672620 Estimation of the cell number after cortical venous ischemia/infarction induced by anterior and posterior anastomotic veins occlusion in a rat model is very important. Twenty male Sprague-Dawley rats were used in this experiment. Small burr-holes were made over the anterior (the crossing point of the line drawn from the posterior border of the orbital rim and the line drawn along the para-midline to the superior sagittal suture) and posterior (just inferior point of the posterior ending of the zygomatic arch) anastomotic veins. Bipolar coagulation technique and micro-scissor were used to sacrifice the venous vessels after final inspection and description. Specimens were evaluated by histopathological and unbiased stereological methods for microscopic evaluation and volumetric analysis, respectively. Significant cell loss was seen in the pyramidal and granule cells of the cornu ammonis and dentate gyrus of the hippocampus after venous ischemia. Cell loss was also pronounced when seen in the histological examination. The present results suggest that the sacrifice of anterior and posterior anastomotic veins can be used as an experimental rat model in the evaluation of pyramidal and granule cell loss in the hippocampus that often assesses the neural damage inflicted by this intervention. (C) 2011 ISDN. Published by Elsevier Ltd. All rights reserved.

DIREN, HALDUN BARIS/0000-0001-8958-2040 WOS: 000251063600009 PubMed: 17948184 Objective: Intraventricular virtual MR endoscopic imaging of the foramen of Monro region by using three-dimensional Fourier transformation constructive interference in steady state (3DFT-CISS) magnetic resonance imaging in a patient with a unilateral congenital obstruction of the foramen of Monro by a transparent membranous septum was performed to enhance the orientation, achieve a better understanding of the pathology, and plan the surgical intervention in an endoscopic approach to the lateral ventricles. Methods: 3DFT-CISS sequences and virtual MR endoscopic imaging were performed in a patient before and after endoscopic fenestration procedures, to communicate the lateral ventricle to the third ventricle for the treatment of unilateral ventricular enlargement. Results: Preoperative 3DFT-CISS imaging demonstrated unilateral membranous septa in the localization of the left foramen of Monro which were not observed with routine T-2-weighted imaging. 3DFT-CISS imaging and T-2-weighted imaging were equally useful for monitoring postoperative changes in the size of the ventricles or cysts and the presence of flow voids after fenestration procedures, but only 3DFT-CISS imaging clearly demonstrated the area of fenestration. Conclusion: Virtual MR endoscopy by using 3DFT-CISS sequences is a feasible method in the planning of intraventricular real-time endoscopic surgery, for the enhancement of orientation in a surgical field, and to achieve a better understanding of the pathology.

DIREN, HALDUN BARIS/0000-0001-8958-2040 WOS: 000241635400001 PubMed: 17041827 Preoperative three-dimensional images with surface venous anatomy may be used in the planning of a linear scalp incision and the opening site of the dura mater for protection of surface veins during surgical dissection, and to find the splitting site of the brain according to the lesion. In 45 patients who had a brain tumor, linear scalp incision planning was done by regarding the three-dimensional images derived from post-contrast time-of-flight (TOF) sequence raw data. The findings of correspondence and the quality of routine contrast-enhanced magnetic resonance imaging (MRI) and three-dimensional volume rendering for tissues (VRT) images were analyzed separately with the surgical findings according to a visual grading system. Our experience revealed that the surgical findings correlated well with the three-dimensional VRT images. According to a visual surgical grading system, a grade III correlation was found in 20 (45%), grade II in 15 (33%), grade I in 7 (15%), and grade 0 in 3 (7%) patients in our study population. At the end of our research we conclude that this method is useful in terms of the preoperative determination of brain surface anatomy and may be used in the determination of the site of a linear scalp incision according to the localization of an intracranial lesion.

Yemisci, Muge/0000-0002-1528-1998; Kaplan, Suleyman/0000-0003-1477-5002 WOS: 000241126800025 PubMed: 16621007 A rat model composed of the sacrifice of the anterior and posterior cortical anastomotic veins by microsurgical techniques was used for the assessment of brain swelling. Twenty male, 15-week-old Sprague-Dawley rats were used in this animal experiment. Small burr-holes were made over the anterior (the intersection of the line drawn from the posterior border of the orbital rim and the line drawn along the para-midline to the superior sagittal suture) and posterior (inferior point of the posterior end of the zygomatic arch) anastomotic veins. After performing a final inspection and describing the venous vessels, they were sacrificed using bipolar coagulation technique and micro-scissors. Specimens were evaluated using histopathological approach, albumin immunostaining technique and a stereological method. Hemispheric swelling, midline shift, brain oedema, subcortical petechial haemorrhagia, ischemia and necrosis were histopathological findings observed in this experimental study. The albumin immumostaining study demonstrated disrupted areas of the blood-brain barrier in the operated hemisphere. Stereological volumetric analysis revealed an 8% brain swelling in the operated hemispheres compared with unoperated ones. Our results suggest that the sacrifice of the anterior and posterior anastomotic veins may be used as an experimental rat model in the evaluation of brain damage and swelling caused by the occlusion of the venous anastomotic outflow. (c) 2006 Elsevier B.V. All rights reserved.

WOS: 000235755900003 PubMed: 15968528 The odontoid process of C2 projects upward from the superior roof of the body of C2. There is a confusion about the inferior border of the odontoid. The aims of this clinical study were to describe the inferior border of the odontoid process based on the remnant of dentocentral synchondrosis in adults, and the estimation of the odontoid/body ratio in pediatric and adult ages. Sixty-six cases were included for this study. Forty-four of them were in adult ages and the remaining 22 of them were in pediatric ages. The region of occiput, C1, C2, and C3, was examined with the magnetic resonance imaging (MRI) in all cases. The length of the odontoid process was estimated by using radiological images of MR from the tip of the odontoid to the remnant of dentocentral synchondrosis. The portion located under the level of synchondrosis was considered as the body of C2. The average length of the odontoid was 18. 6 mm in pediatric and 21. 3 mm in adult cases. In adult females, the length of the odontoid process (19. 1 mm in length) was smaller than those of adult males (23. 6 mm in length). The average ratio of odontoid/body was two in pediatric and 1.8 in adult cases. This study demonstrated that the neck of the odontoid segment at the level of superior articulating facets is not the synchondrosis between the odontoid process and the body of C2. The synchondrosis is located well below the level of superior articulating facets. It can be demonstrated with sagittal and coronal images of MR in both of pediatric and adult individuals.

WOS: 000230681500005 PubMed: 16015491 A new rat model of the sacrifice of the anterior and posterior cortical anastornotic veins by the microsurgical technique was used to evaluate venous infarction. 20 male Sprague-Dawley rats were used in this experiment. Small burr-holes were done over the anterior and posterior anastornotic veins. After the precise description of these vessels, bipolar coagulation and micro-scissor was used for sacrifice. Specimens were evaluated by histopathological techniques. Hemispheric swelling, midline shift, brain edema, subcortical petechial hemorrhage, infarction and necrosis were histopathological findings on the microscopic examination. Our results revealed that the sacrifice of the anterior and posterior anastornotic veins was a very successful model in the evaluation of brain damage after the disturbance to the venous circulation.

Sahin, Bunyamin/0000-0001-8538-8443; Kaplan, Suleyman/0000-0003-1477-5002 WOS: 000235122400009 PubMed: 16432786 Morphological changes of ependyma, subependymal and choroids plexus regions were evaluated after experimental anastomotic venous occlusion in twenty mate Sprague-Dawley rats. In this model, small burr holes were made over the anterior and posterior anastomotic veins and after precisely locating these vessels, bipolar coagulation and microscissors were used to perform permanent occlusion. Three days later, rats were sacrificed by perfusion and fixation and specimens were evaluated by histopathological techniques. Morphological changes of ependymal, subependymal and choroids plexus cells were evaluated in operated and intact hemispheres and revealed cell proliferation in the subventricular zone adjacent to the territory of venous occlusion in the operated hemisphere as well as midline shift, brain oedema, subcortical petechial haemorrhage, brain infarction and hemispheric swelling. In conclusion, following anterior (the vein of Throlard) and posterior (the vein of Labbe) anastomotic vein occlusion, cell proliferation can be seen in the choroids plexus, ependymal and subependymal regions in rats. We conclude that these morphological changes might be part of a self-repairing mechanism in the brain.

WOS: 000223908500009 PubMed: 15343434 In spite of electrodiagnostic examinations, the determination of the precise localization of the injured site along the involved peripheral nerve may remain obscure or uncertain. Before starting the operation, a surgeon should have knowledge about the type of injury, the position of the proximal and distal nerve stumps, and the presence or absence of a neuroma and excessive perilesional scar tissue formation for orientation and planning of the surgical intervention. We hypothesized that real-time ultrasound could be helpful in the determination of the type of injury, the localisation of proximal and distal nerve stumps, as well as for diagnosing a neuroma. Fourteen patients with traumatic peripheral nerve injuries that were verified by neurological examinations and electrodiagnostic tests underwent surgical repair, and were examined by ultrasound before and during the surgical intervention. Visualisation of the injured site, the type of the injury, the position of the nerve stumps and the diagnosis of the neuroma were reliably feasible in all the patients by using ultra sonography. Axonal swelling of a nerve was diagnosed in 4 (29%) patients, a stump neuroma was diagnosed in 3 (21%) patients, a total nerve interruption (neurotmesis in the Seddon classification) was diagnosed in 9 (64%) patients, and surrounding scar tissue was diagnosed in 5 (35%) patients. Presurgical and intraoperative ultrasound-assisted neuroexamination is a useful diagnostic method in the determination of the precise localisation of the injured site, the type of injury, the position of stumps, and the diagnosis of a neuroma. The use of preoperative and intraoperative ultrasound can enhance the orientation of the surgeon to the surgical field. The application of our method to our patients shows that presurgical ultra sonographic neuroexamination can be used in the surgical repair of peripheral nerve injury.

WOS: 000222730100013 PubMed: 15257489 In spite of maximal microsurgical efforts, perilesional neural tissue can be injured by surgical instruments in the process of the separation and dissection of tumors. We hypothesized that transparent microballoon dissection could be helpful in the gentle separation of brain tissue from tumor by minimizing cerebral damage, and in separating sulcal and cisternal walls during surgical interventions on brain masses. We used the transparent microballoon dissection technique in 3 primary cases and 4 metastatic brain tumors that were verified with computed tomography (CT) and magnetic resonance imaging (MRI). Gentle separation of tumor from surrounding brain, reduction of cerebral damage, and separation of sulcal and cisternal walls were feasible in all patients. Postoperative CT and MRI showed satisfactory results in reducing perilesional cerebral damage. The transparent microballoon inflation technique is a useful microsurgical method for the gentle separation of tumors from surrounding brain tissue, minimizing cerebral damage, and separating sulcal and cisternal walls during surgical interventions for brain masses. Our conclusion is that using the microballoon dissection method may be suitable in microneurosurgical practice.

WOS: 000189387900015 PubMed: 14968409 Patients who underwent craniotomy occasionally complain about the postoperative cosmetic appearance at the site of burr holes on the scalp. This problem occurs as a result of depletion of the skin into the unreconstructed burr holes. Some materials have been developed for reconstruction of craniotomy burr holes. To prevent the postoperative cosmetic deformity, the authors developed a button-shaped autologous bone graft harvested from the inner table of craniotomy flap. Clinical application of this method is described.

BAYDIN, AHMET/0000-0003-4987-0878 WOS: 000245478200030 PubMed: 17272915 …