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Öğe Addressing silicone ventriculoperitoneal shunt hypersensitivity with teflon sheets: a case report(Cambridge Media, 2024) Biceroglu, Huseyin; Akbulut, Bilal Bahadir; Turhan, Tuncer; Yurtseven, TaskinVentriculoperitoneal (VP) shunts, used to treat hydrocephalus, can sometimes cause hypersensitivity reactions to silicone, necessitating repeated surgical interventions. Traditional management involves replacing silicone with alternatives like polyurethane, which have limitations. This study presents a novel approach using Teflon (PTFE) sheets to cover the silicone valve surface. A 22-year-old male with a history of multiple shunt surgeries and wound revisions was admitted for wound dehiscence, suspected to be due to a late hypersensitivity reaction to silicone. The shunt valve and cranial entry point were wrapped in Teflon PTFE felt sheets, and the wound was closed with propylene sutures. The patient was treated with methylprednisolone and discharged after three days. Follow-up showed complete wound healing within a month, and the patient remained revision-free for ten years. This case suggests that Teflon sheets may offer a promising approach for managing silicone hypersensitivity in VP shunts, though further studies are needed to determine its broader applicability.Öğe Cavernous Sinus and Parasellar Region: An Endoscopic Endonasal Anatomic Cadaver Dissection(Lippincott Williams & Wilkins, 2018) Erdogan, Umut; Turhal, Goksel; Kaya, Isa; Biceroglu, Huseyin; Midilli, Rasit; Gode, Sercan; Karci, BulentThe aim of this study was to investigate the neurovascular structures of the cavernous sinus with the endonasal endoscopic transpterygoid approach on fresh human cadavers. Additionally, the course of internal carotid artery (ICA) and relevant anatomy was thoroughly investigated to refine the anatomical landmarks, exposure difficulties, potential complications, and limitations using the endonasal endoscopic technique. This study was carried out at an otolaryngology department of a tertiary medical center between June 2014 and June 2015. The surgical dissection was performed on 10 fresh human cadaver specimens using paranasal sinus and skull base endoscopic instruments. Cavernous sinuses and parasellar area were explored via an endoscopic endonasal transpterygoid approach. Dehiscence was present in 5 (25%) cavernous ICAs. Projection of the cavernous ICA on the whole lateral sphenoid wall was prominent in 6 (%30) sphenoid sinuses. Anterior curve was prominent in 12 (60%) cavernous ICAs, whereas posterior was prominent in 7 (35%). Mean distance between the lateral wall of eustachian tube orifice and petrous ICA was 19.50 +/- 1.05 mm (range 18-22 mm). Cranial nerves of the cavernous sinus showed no variation. Control of the ICA is critical during the endonasal endoscopic approach to the cavernous sinus and skull base. The vidian nerve is a reliable and important landmark to the petrous ICA in the transpterygoid approach. Dissection of the eustachian tube and its relation to the ICA has to be kept in mind during nasopharyngeal surgery.Öğe Comparison between Rescue Flap and Double Flap Technique(Thieme Medical Publ Inc, 2019) Benzer, Murat; Biceroglu, Huseyin; Ates, Murat Samet; Kaya, Isa; Ozgiray, Erkin; Midilli, Rasit; Karci, Bulent; Gode, SercanObjectives Endoscopic techniques in pituitary surgery lead to inevitable mucosal loss of the sphenoethmoidal recess and posterior nasal septum in the nasal cavity. There is no other comparative study between primary reconstruction of septal perforation and secondary healing in the literature. The aim of this study is to evaluate postoperative patient morbidity with or without posterior septal perforation in endonasal pituitary surgery by comparing two commonly used techniques: rescue and double nasoseptal flaps. Design Prospectively randomized study. Setting Tertiary academic center. Participants Sixty patients underwent endoscopic endonasal pituitary surgery. Main Outcomes and Measures Functional results (breathing) using visual analog scale (VAS), sphenoid sinusitis, presence of synechia, perforation in the posterior septum, and crusting in the sphenoethmoidal recess were assessed. Results Pre- and postoperative mean VAS scores were 71.67 +/- 11.47 and 67.67 +/- 9.71 mm in the intact septum group and 77.67 +/- 14.06 and 62.67 +/- 10.48 mm in the posterior septal perforation group. There was a significant difference between pre- and postoperative VAS values in all groups. There was significant worsening in both groups; worsening in VAS values was much higher in the posterior septal perforation group. In the posterior septal perforation group, much more crusting was seen. Conclusions This is the first study to compare the postoperative patient morbidity in endoscopic endonasal pituitary surgery with and without a posterior septal perforation. Reconstruction of the posterior septum along with less mucosal loss yields better postoperative nasal symptom score.Öğe Computed tomography vs. magnetic resonance imaging in unstable cervical spine injuries(Turkish Assoc Trauma Emergency Surgery, 2020) Kodik, Meltem Songur; Eraslan, Cenk; Kitis, Omer; Altunci, Yusuf Ali; Biceroglu, Huseyin; Akay, AliBACKGROUND: This study aimed to investigate the role of computed tomography (CT) in identifying missed unstable blunt cervical injuries. METHODS: Patients admitted to the emergency department between June 2014 and June 2018 with a diagnosis of blunt cervical trauma were included in this study. All participants underwent cervical magnetic resonance imaging (MRI) after an initial cervical CT investigation. All imaging results were reviewed, and decisions were taken by the consensus of a team consisting of an emergency medicine specialist, a neuroradiologist, and a neurosurgeon. Other variables included age, sex, the Glasgow Coma Scale, medical comorbidities, multi-trauma, neurological deficits, accompanying intracranial hemorrhage, extremity fractures, and the mechanism of the injury. RESULTS: Data for 195 patients were analyzed. the mean (+/- standard deviation) age of the participants was 47.34 +/- 21.90 years, and 140 (71.8%) were males. Eighteen patients (9.2%) were below age <18. the most frequent mechanism of injury was fall from height (n=100; 51.3%). Using MRI as the gold standard, the sensitivity of CT in diagnosing unstable cervical injury was 77.7% (95% CI [67.1-86.1]), while its specificity was 100.0% (95% CI [59.0-100.0]). CONCLUSION: Although computed tomography is relatively good in diagnosing unstable cervical injuries, its sensitivity in detecting positive cases is not as successful. Thus, the use of MRI in patients with an unstable injury seems to be warranted.Öğe Creation of 3-Dimensional Life Size: Patient-Specific C1 Fracture Models for Screw Fixation(Elsevier Science Inc, 2018) Govsa, Figen; Ozer, Mehmet Asim; Biceroglu, Huseyin; Karakas, Asli Beril; Cagli, Sedat; Eraslan, Cenk; Alagoz, Ahmet KemalBACKGROUND: Transarticular screw fixation has fatal complications such as vertebral artery (VA), carotid artery, and spinal cord injuries. The landmarks for deciding the entry point for C1 lateral mass screws were clarified by using life-size 3-dimensional (3D) patient-specific spine models. METHODS: This study included a total of 10 patients with Cl fractures. Dual-energy computed tomography (CT) scan data from Cl pre- and postscrewing were modified into 3D patient-specific life-size cervical spine models. The detailed information, such as bony and vascular elements, of 13 separate parameters of Cl was used as an intra-operative reference. RESULTS: 3D patient-specific models were created preoperatively with the fracture and postoperatively with the screwed vertebrae. After CT scans of the models were measured, the life-size patient-specific models were proven to be individualized. 3D models assisted in determining the fracture locations, pedicle sizes, and positions of the VA. The range of the measurements for ideal point of entry reveals the need for patient-specific intervention was required, CONCLUSIONS: 3D models were used in surgical planning maximizing the possibility of ideal screw position and providing individualized information concerning cervical spinal anatomy, The individualized 3D printing screw insertion template was user-friendly, of moderate cost, and it enabled a radiation-free cervical screw insertion.Öğe Double nasoseptal flap technique for endonasal pituitary surgery(Springer, 2017) Gode, Sercan; Biceroglu, Huseyin; Turhal, Goksel; Erdogan, Umut; Ates, Murat S.; Kaya, Isa; Ozgiray, Erkin; Midilli, Rasit; Karci, BulentEndoscopic endonasal approach has been successfully used for the management of pituitary tumors; however, the loss of septal mucosa especially around sphenoethmoidal recess and posterior nasal septum might be a disadvantage of this technique. The aim of this study is to describe a variation of the endonasal approach, "double nasoseptal flap'' technique in endoscopic transsphenoidal pituitary surgery, and to evaluate its outcomes. The technique depends on fully harvested bigger nasoseptal flap on one side and smaller on the other. Thirty patients were included. Functional results were assessed by preoperative and postoperative first month visual analogue scale (VAS), and morphology was evaluated by achieving intact septum from the sphenoid ostium to the columella. Sphenoid sinusitis, the presence of synechia and crusting in the sphenoethmoidal recess was also assessed. Mean VAS was 71 and 67 mm preoperatively and postoperatively, respectively (p > 0.01). There were no septal perforations, synechia, and sphenoid sinusitis postoperatively. Three patients had (10 %) crusts on sphenoethmoidal recess on first month postoperatively. Double nasoseptal flap technique has advantages, such as wider exposure during surgery; prepared flaps could be used if needed, better morphological and functional outcomes postoperatively. The technique is safe without any perforations and minimal crusting.Öğe The Effect of Endoscopic Endonasal Transsphenoidal Skull Base Surgery on Cochlear Function(Thieme Medical Publ Inc, 2019) Ates, Murat Samet; Benzer, Murat; Kaya, Isa; Biceroglu, Huseyin; Ozgiray, Erkin; Midilli, Rasit; Gode, SercanEndoscopic transsphenoidal skull base surgery (ETSS) has become a standard approach in the treatment of sellar and clival lesions, such as pituitary adenoma and chordoma. Due to the close proximity of the clivus and the sella turcica to the inner ear, it is thought that bone drilling in the surgery may have effects on hearing. the aim of this study was to assess the effect of bone drilling in ETSS procedure on cochlear function. This study was performed on 18 patients who underwent ETSS procedure between December 2016 and May 2017. the study was designed as a prospective study. All of the data were prospectively collected. These included demographic data, date of surgery, type of surgery, preoperative pure-tone audiometry, and preoperative and postoperative distortion product otoacoustic emission (DPOAE) measurements. of the DPOAE measurements of the patients who were operated for pituitary adenoma, there was a statistically significant difference between the signal-to-noise ratio (SNR) measurements at 0.5, 1, 2 and 4 kHz ( p < 0.05). Additionally, there were no significant differences in preoperative and postoperative SNR measurements of six patients who were selected for clivus chordoma. When the preoperative and postoperative tonal audiometric tests of the patients were compared, no statistically significant difference was found ( p > 0.05). in conclusion, it is found that bone drilling in ETSS procedure has a negative effect on cochlear function in the early period. This is the first study to evaluate the degree of noise-induced cochlear damage in patients who were gone under ETSS procedure.Öğe The Effect of Preoperative Three Dimensional Modeling and Simulation on Outcome of Intracranial Aneursym Surgery(Korean Neurosurgical Soc, 2024) Ozgiray, Erkin; Husemoglu, Bugra; Cinar, Celal; Bolat, Elif; Akinturk, Nevhis; Biceroglu, Huseyin; Kizmazoglu, CerenObjective : Three-dimensional (3D) printing in vascular surgery is trending and is useful for the visualisation of intracranial aneurysms for both surgeons and trainees. The 3D models give the surgeon time to practice before hand and plan the surgery accordingly. The aim of this study was to examine the effect of preoperative planning with 3D printing models of aneurysms in terms of surgical time and patient outcomes. Methods : Forty patients were prospectively enrolled in this study and divided into two groups : groups I and II. In group I, only the angiograms were studied before surgery. Solid 3D modelling was performed only for group II before the operation and was studied accordingly. All surgeries were performed by the same senior vascular neurosurgeon. Demographic data, surgical data, both preoperative and postoperative modified Rankin scale (mRS) scores, and Glasgow outcome scores (GOS) were evaluated. Results : The average time of surgery was shorter in group II, and the difference was statistically significant between the two groups (p<0.001). However, no major differences were found for the GOS, hospitalisation time, or mRS. Conclusion : This study is the first prospective study of the utility of 3D aneurysm models. We show that 3D models are useful in surgery preparation. In the near future, these models will be used widely to educate trainees and pre -plan surgical options for senior surgeons.Öğe Evaluating the efficacy of a cost-effective, fully three-dimensional-printed vertebra model for endoscopic spine surgery training for neurosurgical residents(Korean Soc Spine Surgery, 2024) Akbulut, Bilal Bahadir; Boluk, Mustafa Serdar; Biceroglu, Huseyin; Yurtseven, TaskinStudy Design: A fused deposition modeling three-dimensional (3D)-printed model of the L4-5 vertebra for lumbar discectomy was designed. The model included separately printed dura mater, spinal cord, ligamentum flavum, intervertebral disc (from thermoplastic polyurethane), and bony structures (from polylactic acid), and the material cost approximately US$ 1 per model. A simple plumbing endoscope was used for visualization. Dura mater injury was assessed by painting two layers on the dura mater, which peeled off with trauma. Purpose: Endoscopic spine surgery is a subject of high interest in neurosurgery given its minimally invasive nature; however, it has a steep learning curve. This study evaluated the effectiveness of a cost-efficient 3D-printed model when teaching this technique to neurosurgery residents. Overview of Literature: Only a few studies have investigated the efficacy of such a model. Methods: Eight residents with >2 years of training participated. Residents performed the procedure bilaterally and twice at 1-week intervals. Results: From the 32 surgeries, four were excluded because of facet removal (as it widened the surgical corridor), leaving 28 surgeries for analysis. Initial surgeries demonstrated a mean operation time of 21 minutes 18 seconds (standard deviation [SD], 2 minutes 32 seconds), which improved to a mean of 6 minutes 45 seconds (SD, 37 seconds) in the fourth surgery (F(3, 17)=19.18, p <0.0001), demonstrating a significant reduction in surgical time over successive surgeries. The median area with the paint removed decreased, from 161.80 (85.55-217.83) to 95.13 mm2 2 (12.62-160.54), (F(2.072, Inf)=2.04, p =0.128); however, this was not significant. Resident feedback indicated high satisfaction with the educational value of the model. Conclusions: The developed fully 3D-printed model provides a viable and scalable option for neurosurgical training programs, enhancing the learning experience while maintaining low costs. This model may be an excellent stepping stone for learning lumbar spine endoscopy, acclimating to the two-dimensional view, progressing to cadaver models, and, eventually, independent surgery.Öğe Mammillothalamic and Mammillotegmental Tracts as New Targets for Dementia and Epilepsy Treatment(Elsevier Science Inc, 2018) Balak, Naci; Balkuv, Ece; Karadag, Ali; Basaran, Recep; Biceroglu, Huseyin; Erkan, Buruc; Tanriover, NecmettinBACKGROUND: Recently, neuromodulation through deep brain stimulation (DBS) has appeared as a new surgical procedure in the treatment of some types of dementia and epilepsy. The mammillothalamic and mammillotegmental tracts are involved among the new targets. To our knowledge, a review article focused specifically on these mammillary body efferents is lacking in the medical literature. Their contribution to memory is, regrettably, often overlooked. METHODS: A review of the relevant literature was conducted. RESULTS: There is evidence that mammillary bodies can contribute to memory independently from hippocampal formation, but the mechanism is not yet known. Recent studies in animals have provided evidence for the specific roles of these mammillary body efferents in regulating memory independently. In animal studies, it has been shown that the disruption of the mammillothalamic tract inhibits seizures and that electrical stimulation of the mammillary body or mammillothalamic tract raises the seizure threshold. In humans, DBS targeting the mammillary body through the mammillothalamic tract or the stimulation of the anterior thalamic nucleus, especially in the areas closely related to the mammillothalamic tract, has been found effective in patients with medically refractory epilepsy. Nonetheless, little knowledge exists on the functional anatomy of the mammillary body efferents, and their role in the exact mechanism of epileptogenic activity and in the memory function of the human brain. CONCLUSIONS: A comprehensive knowledge of the white matter anatomy of the mammillothalamic and mammillotegmental tracts is crucial since they have emerged as new DBS targets in the treatment of various disorders including dementia and epilepsy.Öğe The Microsurgical Anatomy of the Anterior Commissure(Gazi Univ, Fac Med, 2019) Baydin, Sevki Serhat; Biceroglu, HuseyinAim: the anterior comissure, that is a commissural fibers, connects frontal, temporal and occipital areas of the each hemispheres. Our aim is exposing the anterior commissure and it's segmantation's with white matter dissection technique in this study. Material and Method: Our study was performed eight human cadaver heads. Klingler's White matter dissections technique was used. Results: the anterior comissure was dissected from lateral and medial surface gradually. It locates on inferior and posterior of th erostrum of the corpus callosum on medial surface. Also, the anterior comissure is formed anterior border of the third ventricle. Dissection from lateral surface, it locates in the anterior base of lentiform nucleus obliquelly. the anterior commissure has five segments; corpus, anterior and posterior limb, temporal and occipital fibers. Discussion: the anterior-posterior commissure line, as bicommissural line is indispensable for surgery. in some cases, after callosotomy that uses epilepsy surgery, the resistans epileptic atacts still continue.The cause of this atacts is the anterior commissure and so it must be damaged during the callosotomy surgery. Conclusion: the white matter studies aid to better understand of the deep brain structures. Thus, we can perform the intraaxial surgeries more safely, and treat to the neuronal structires more kindly.Öğe Pain intensity, spine structure, and body composition in patients with acute discogenic lumbar radiculopathy(Elsevier, 2024) Kaya, Derya Ozer; Celenay, Seyda Toprak; Secer, Erhan; Biceroglu, HuseyinObjective: This study aimed to compare the pain intensity, spine structure, and body composition according to functional disability levels in patients with acute discogenic lumbar radiculopathy (DLR). Methods: A total of 118 women (n = 83) and men (n = 35) patients with acute DLR (mean age: 51.87 +/- 13.38 years) were included in the study. The function ability was measured with the Oswestry Disability Index, pain intensity was measured with the Visual Analogue Scale, spine structure was measured with the Spinal Mouse (R) device, and body composition was measured with the Bioelectrical Impedance Analysis System. Results: Patients with mild functional disability levels had significantly lower activity (p<.001) and night pain intensity (p = 0.001) than patients with moderate, severe, and completely functional disability levels, and patients with completely functional disability levels had significantly higher rest pain intensity (p = 0.005) than patients with mild, moderate, and severe functional disability levels. Patients with mild functional disability levels had significantly better spine check scores (p = 0.001), posture (p = 0.005), and mobility (p = 0.003) than patients with moderate, severe, and completely functional disability levels. Patients with mild functional disability levels had significantly lower fat percentage (p = 0.032), and higher basal metabolic rate (p = 0.024) than patients with moderate, severe, and completely functional disability levels. Conclusion: Pain intensity, spinal structure, and body composition of acute DLR patients differ greatly according to their functional disability levels. Although it is known that the level of functional disability of patients is a result of the severity or prognosis of the disease, performing different treatment methods aimed at decreasing the functional disability level of patients by health professionals may be important in terms of coping with the disease.Öğe Subdural Empyema Caused by Brucellosis: A Case Report and Review of the Literature(Galenos Publ House, 2024) Akbulut, Bilal Bahadir; Erol, Anil; Boluk, Mustafa Serdar; Yurtseven, Taskin; Eraslan, Cenk; Arda, Bilgin; Biceroglu, HuseyinNeurobrucellosis is a rare and challenging complication of brucellosis. Its non-specific clinical presentation makes it challenging to diagnose. The coexistence of neurobrucellosis with subdural empyema is extremely rare, with only a few cases reported in the literature. Herein, we present the case of a 27-year-old male with a ventriculoperitoneal shunt in-situ and a history of exposure to Brucella via animal care and consumption of raw milk. The patient presented with a left frontal headache and vertigo following a head trauma. The initial cranial imaging demonstrated a left-sided subdural hematoma and slit ventricles. The patient underwent drainage by craniotomy. Brucella spp. was detected in the drained sample, and the patient was treated with a multi-modal approach, which included antibiotics and surgical drainage. The follow-up plan involved a repeat cranial computed tomography and shunt adjustment for recurrent subdural effusions. This case adds to the few reports of neurobrucellosis associated with subdural empyema. Furthermore, it highlights the importance of considering neurobrucellosis in patients with neurological symptoms and a subdural collection in brucellosis-endemic areas.Öğe Variations in Toll-like receptor and nuclear factor-kappa B genes and the risk of glioma(Taylor & Francis Ltd, 2019) Klna, Idris; Sultuybek, Gonul Kanigur; Soydas, Tugba; Yenmis, Guven; Biceroglu, Huseyin; Dirican, Ahmet; Uzan, Mustafa; Ulutin, TurgutPurpose: Glioblastoma (GBM) is the most aggressive primary brain tumour in the adult nervous system and is associated with a poor prognosis. NF-KB activation is an important driver of the malignant phenotype that confers a negative prognosis in patients with GBM. NF-KB plays a role in Toll-like Receptors (TLR)-induced tumourigenesis. The aim of the present study was to investigate the association of a promoter region polymorphism of NFKB1 gene encoding the p50 subunit of NF-KB, namely -94ins/del ATTG, the most widely discussed the TLR2 Arg753Gln, TLR4Asp299Gly and TLR4Thr399Ile polymorphisms, their combined effects, and the glioma risk. Methods: A group of 120 Glioma patients and 225 control subjects were screened for these four polymorphisms using the PCR-RFLP method. Results: Statistical analysis indicates that the ins/ins genotype of NFKB -94ins/delATTG (p=0.003), and the AA genotype of TLR4Asp299Gly (p < 0.001) are risk factors for glioma and people carrying the ins allele have an approximately 1.47 times susceptibility risk of glioma whereas GG genotype of TLR2Arg753Gln seems to be protective against glioma (p = 0.002). Combined genotype analysis showed that del/ins-GG genotype of TLR2Arg753Gln-NFKB1, del/ins + GG genotype of TLR4Asp299Gly-NFKB1, del/ins-CC genotype of TLR4Thr399Ile-NFKB1 were risk factors for glioma development. Conclusion: NFKB1 -94ins/delATTG and TLR4Asp299Gly polymorphisms are associated with increased glioma cancer risk in a Turkish population.
