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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 The Association of Alagille Syndrome and Craniosynostosis(Elsevier Science Inc, 2013) Yilmaz, Sanem; Turhan, Tuncer; Mutluer, Saffet; Aydogdu, SemaAlagille syndrome is associated with various ocular abnormalities, including pseudopapilledema or optic disk edema due to increased intracranial pressure. Several mechanisms have been proposed to explain the mechanism of intracranial hypertension in Alagille syndrome. Craniosynostosis is an unusual but significant cause of increased intracranial hypertension in Alagille syndrome. It has recently been demonstrated in animal models that Jaggedl gene in which mutations are responsible for Alagille syndrome may also take part in cranial suture formation. We report a child with Alagille syndrome and craniosynostosis who presented with pruritus, elevated liver enzymes, and suspected increased intracranial pressure. (C) 2013 Elsevier Inc. All rights reserved.Öğe The Association of Alagille Syndrome and Craniosynostosis(Elsevier Science Inc, 2013) Yilmaz, Sanem; Turhan, Tuncer; Mutluer, Saffet; Aydogdu, SemaAlagille syndrome is associated with various ocular abnormalities, including pseudopapilledema or optic disk edema due to increased intracranial pressure. Several mechanisms have been proposed to explain the mechanism of intracranial hypertension in Alagille syndrome. Craniosynostosis is an unusual but significant cause of increased intracranial hypertension in Alagille syndrome. It has recently been demonstrated in animal models that Jaggedl gene in which mutations are responsible for Alagille syndrome may also take part in cranial suture formation. We report a child with Alagille syndrome and craniosynostosis who presented with pruritus, elevated liver enzymes, and suspected increased intracranial pressure. (C) 2013 Elsevier Inc. All rights reserved.Öğe Atypical teratoid/rhabdoid tumor of the central nervous system: clinicopathologic and immunohistochemical features of four cases(Springer, 2009) Ertan, Yesim; Sezak, Murat; Turhan, Tuncer; Kantar, Mehmet; Ersahin, Yusuf; Mutluer, Saffet; Vergin, Canan; Oniz, Haldun; Akalin, TanerAtypical teratoid/rhabdoid tumor (AT/RT) is a rare aggressive infantile neoplasm of uncertain origin. This study was performed to assess the clinicopathologic and immunohistochemical features of four AT/RT cases. Two cases were male and two were female, and their ages ranged from 8 to 103 months. Tumors were located in the cerebellum (two cases), frontoparietal lobe (one case), and third ventricle (one case). Histopathologically, the tumors were composed of rhabdoid cells and undifferentiated small cells mixed with epithelial or mesenchymal components. However, one of the tumors was composed predominantly of a mesenchymal component mimicking a sarcoma. Immunohistochemically, vimentin (4/4), epithelial membrane antigen (4/4), cytokeratin (3/4), smooth muscle actin (4/4), glial fibrillary acidic protein (4/4), S-100 (4/4), and synaptophysin (1/4) were positive in varying proportions, while desmin and INI-1 were negative in all the cases. All of the patients died within a mean of 14 months due to tumor progression despite the chemotherapy. Only one of our patients lived for 40 months after the diagnosis. In conclusion, AT/RTs are aggressive tumors. They can occur in a variety of locations, such as the third ventricle. Morphologically, a large spectrum can be seen, like predominantly sarcoma in appearance, but immunohistochemistry is helpful in the correct diagnosis.Öğe Ceftaroline versus vancomycin in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) in an experimental MRSA meningitis model(Elsevier Sci Ltd, 2020) Mermer, Sinan; Turhan, Tuncer; Bolat, Elif; Aydemir, Sohret; Yamazhan, Tansu; Pullukcu, Husnu; Sipahi, Oguz ResatObjectives: the aim of this study was to compare the antibacterial activity of ceftaroline versus vancomycin in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) meningitis in an experimental rabbit meningitis model. Methods: the antibacterial activity of ceftaroline was compared with vancomycin in the treatment of meningitis induced by MRSA strain ATCC 43300 in an experimental rabbit meningitis model. Quantitative cerebrospinal fluid (CSF) cultures were performed at the beginning of antibiotic treatment and 24 h and 73 h after the first antibiotic dose. Furthermore, in vitro time-kill data were investigated at 0, 2, 4, 6, 8, 12 and 24 h in sterile human serum. Results: the difference between the control group versus both treatment groups was significant when comparing the decrease in colony counts in CSF both at 24 h and 73 h after the first antibiotic dose (P < 0.05). At the end of the experiment, there was a significant difference in survival between both the ceftaroline-treated group and the vancomycin-treated group versus the control group, but not between the two treatment groups. Conclusion: These results suggest that the antibacterial activity of both ceftaroline and vancomycin are similar in the treatment of MRSA meningitis in an experimental rabbit meningitis model. (C) 2020 the Authors. Published by Elsevier Ltd on behalf of International Society for Antimicrobial Chemotherapy.Öğe Cerebro-Spinal Fluid Shunt Revisions, Importance of the Symptoms and Shunt Structure(Turkish Neurosurgical Soc, 2011) Turhan, Tuncer; Ersahin, Yusuf; Dinc, Muhammet; Mutluer, SaffetAIM: CSF shunt failure is still a frequent problem in children. This prospective study was designed for focusing symptoms and reasons of shunt failure. We also especially focused on the mechanical reasons of shunt failure. MATERIAL and METHODS: We focused on the causes of shunt failures, and the symptoms and signs in patients who were operated for shunt malfunction between January 1, 2001 and December 31, 2005 in the neurosurgery department. All examination and operative data were collected prospectively. Evaluation of these data was with the chi-square and Fisher exact tests. RESULTS: After the evaluation of data on 111 patients and 153 revision procedures, the major symptoms in this group were vomiting (62.16%), somnolence (59.45%) and headache (48.64%). In the majority of the shunt revisions (115 operations, 75.2% of the all 153 procedures), one or more mechanical problems of the shunt systems were identified in surgery. CONCLUSION: Shunt failures in children sometimes appear with very unusual symptoms. Also, probable structural problems of the shunt systems seem very important for shunt failure according to patient characteristics and etiology of the hydrocephalus. A systematic approach including CT, shunt series and abdominal ultrasound is needed to rule out shunt malfunction.Öğe Çocukluk Çağı Olgularda Spinal Deformitelere Yaklaşım: Erişkin Olgulardan Farklılıklar(2023) Bolat, Elif; Turhan, TuncerPediatrik omurgada, konjenital, gelişimsel veya kazanılmış olmak üzere çeşitli patolojiler görülebilmektedir. Pediatrik omurga patolojileri erişkin patolojilerinden belirgin farklılıklar göstermekle birlikte bunların tedavileri de özellik arz eder. Pediatrik yaş grubunda küçük anatomi ve büyümeye devam eden omurga varlığı, pediatrik yaş grubuna özel enstrümanların yetersizliği, erişkin cerrahi tekniklerin çocuklara uygulanamaması gibi faktörler, pediatrik omurga patolojilerinde cerrahi tedaviyi zorlaştırmaktadır. Gelişimini tamamlamamış omurganın füzyonuna neden olmak, büyüme geriliğinin ötesinde çok daha önemli problemlere yol açmaktadır. Çocuklarda omurga cerrahisinin geleceği, büyümeye izin veren ve hareketi koruyan füzyonsuz tekniklerinin geliştirilmesine bağlıdır. Yeni teknolojilerle geliştirilecek olan spinal enstrümantasyon teknikleri, büyümeye devam eden pediatrik omurga patolojilerinin kusursuz tedavisi için umut verici olacaktır.Öğe Comparison of the Effectiveness of Ceftobiprole and Vancomycin in a Rabbit Model of Methicillin-Resistant Staphylococcus aureus-Induced Meningitis(Karger, 2024) Mermer, Sinan; Turhan, Tuncer; Bolat, Elif; Aydemir, Sohret; Sipahi, Hilal; Sipahi, Oguz ResatIntroduction: Nosocomial meningitis may occur after procedures affecting the central nervous system or following traumatic injury. The causative infectious organism is commonly Staphylococcus aureus, a Gram-positive bacterium. The aim of the present study was to compare the effectiveness of two antibacterial agents, ceftobiprole and vancomycin, in an animal model of methicillin-resistant S. aureus (MRSA) meningitis. Method: The strain of MRSA used was ATCC 43300. The animals were divided into three groups and infected intracisternally with MRSA. Controls received no antibiotherapy while the ceftobiprole group received 25 mg/kg and the vancomycin group received 20 mg/kg intravenously. Blood and cerebrospinal fluid (CSF) samples were collected at three time points. All animals were euthanized at 73 h after start of treatment. Results: There was a significant difference (p < 0.05) between both treatment groups and the control animals at 24 h (drug trough) and 73 h (1 h after third dose) after start of treatment in terms of CSF bacterial levels. At 73 h, there was a significant difference in survival between the control group and the two treatment groups but no difference between the treated animal survival rates. Conclusion: Intravenous treatment with ceftobiprole and vancomycin appears to be equally effective in a rabbit model of MRSA meningitis.Öğe Daptomycin versus Vancomycin in Treatment of Methicillin-Resistant Staphylococcus aureus Meningitis in an Experimental Rabbit Model(Amer Soc Microbiology, 2013) Bardak-Ozcem, Selin; Turhan, Tuncer; Sipahi, Oguz Resat; Arda, Bilgin; Pullukcu, Husnu; Yamazhan, Tansu; Isikgoz-Tasbakan, Meltem; Sipahi, Hilal; Ulusoy, SercanIn this study, we aimed to compare the antibacterial activities of daptomycin and vancomycin in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) meningitis (induced by MRSA strain ATCC 43300) in an experimental rabbit meningitis model. After an 8-h period of treatment, bacterial counts decreased significantly in both treatment groups compared to the control group (P<0.05). However, there was no statistically significant difference between treatment groups. Our results suggest that the antibacterial activity of daptomycin is similar to vancomycin for treatment in the experimental MRSA meningitis model in rabbits.Öğe Daptomycin versus Vancomycin in Treatment of Methicillin-Resistant Staphylococcus aureus Meningitis in an Experimental Rabbit Model(Amer Soc Microbiology, 2013) Bardak-Ozcem, Selin; Turhan, Tuncer; Sipahi, Oguz Resat; Arda, Bilgin; Pullukcu, Husnu; Yamazhan, Tansu; Isikgoz-Tasbakan, Meltem; Sipahi, Hilal; Ulusoy, SercanIn this study, we aimed to compare the antibacterial activities of daptomycin and vancomycin in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) meningitis (induced by MRSA strain ATCC 43300) in an experimental rabbit meningitis model. After an 8-h period of treatment, bacterial counts decreased significantly in both treatment groups compared to the control group (P<0.05). However, there was no statistically significant difference between treatment groups. Our results suggest that the antibacterial activity of daptomycin is similar to vancomycin for treatment in the experimental MRSA meningitis model in rabbits.Öğe Dry-field maneuver for controlling the massive intraventricular bleeding during neuroendoscopic procedures(Springer, 2018) Turhan, TuncerMassive hemorrhages pose a significant problem in intraventricular endoscopic surgeries. These hemorrhages have the potential to cause mortality and morbidity, particularly in excisional surgeries. Often, the bleeding can be controlled only by cauterization and liquid irrigation, due to the incongruity of the use of antihemorrhagic agents in the fluid. The final option to stop the massive bleeding is the dry-field maneuver. In this study, the effects and clinical results of the dry-field maneuver in bleeding control of a massive bleeding were investigated. Dry-field maneuver was retrospectively studied in a patient population that had massive bleeding during intraventricular endoscopic procedures. Dry-field maneuver was used in seven patients. Four of these patients underwent some excisional surgery. The other two patients were operated for an endoscopic third ventriculostomy and one for intraventricular hemorrhage evacuation. It was observed that the hemorrhage in patients stopped rapidly after the dry-field maneuver. Moreover, there was no need for an antihemorrhagic material. Dry-field maneuver is an option for providing hemostasis, particularly, for a massive hemorrhage. It also has the potential to be used in elective surgeries because it improves the visual quality.Öğe The Effect of Vagal Nerve Stimulation on the Quality of Life in Pediatric Cases(Galenos Yayincilik, 2017) Tekin, Hande Gazeteci; Kose, Sezen; Gokben, Sarenur; Erermis, Serpil; Turhan, Tuncer; Tekgul, Hasan; Yilmaz, Sanem; Serdaroglu, GulAim: To evaluate the value of vagal nerve stimulation (VNS) in improving the quality of life, seizure frequency and mood in children with pharmacoresistant epilepsy. Materials and Methods: Eleven pharmacoresistant epileptic children implanted with the VNS therapy device between 2010-2014 were included in this prospective longitudinal study. Clinical assessment for the Diagnostic and Statistical Manual of Mental Disorders-IV psychiatric disorders, schedule for affective disorders, and schizophrenia for school children were applied. Childhood Depression Inventory (CDI), Beck Depression Inventory (BDI) were filled. Child Behavior Checklist (CBCL) and the Pediatric Quality of Life Inventory (PedsQL) were filled in by parents before the implantation. All of these tests were repeated in the first and second year of implantation. Results: Mean age at the first implantation of the VNS therapy device was 11.5 (2.5-16). Mean age was 13.9 (2.5-18) years. Mean duration of epilepsy prior to VNS implantation was 6.6 years, and VNS usage period was 30.4 months (10-96). International League Against Epilepsy classification of predominant seizure type was partial in seven, and generalized in four patients. Decrease in the number of seizures was 42% and 43% in the first and the second year respectively. While four of 11 patients had no psychopathology, different problems were determined in seven patients. There was no statistically significant difference between the scores of CDI/BDI, scores of CBCL and PedsQL prior to implantation, and also did not differ 1 year and 2 years after implantation. Conclusion: VNS is partially effective in controlling drug-resistant epilepsy. Although a positive effect on depression and quality of life is reported in literature, the results of this study were not statistically significant. We think that the scores of depression inventory should gradually decrease in years as it is reported for seizure frequency.Öğe Endoscopic evacuation of cerebellar hematoma in a term newborn(Elsevier Science Bv, 2013) Tanriverdi, Sema Rala; Turhan, Tuncer; Uygur, Ozgun; Koroglu, Ozge Altun; Yalaz, Mehmet; Kultursay, NilgunIntracerebellar hemorrhage is very rare in term infants and only severe cases with massive intracranial hemorrhage, posthemorrhagic hydrocephalus and clinical deterioration due to increased intracranial pressure require neurosurgical evacuation. In recent adult studies endoscopic hematoma evacuation has been shown as a rapid, effective, and safe technique. A term newborn hospitalized for meconium aspiration syndrome showed hypertonia, jitteriness and abnormal amplitude integrated electroencephalogram findings. He was diagnosed with cerebellar hematoma which caused hydrocephalus by cranial magnetic resonance imaging (MRI). The hematoma was successfully evacuated neuroendoscopically as the first case in literature to our knowledge. Neurologic, a-EEG and MRI findings resolved. (C) 2012 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.Öğe Excellent response to deep brain stimulation in a young girl with GNAO1-related progressive choreoathetosis(Springer, 2016) Yilmaz, Sanem; Turhan, Tuncer; Ceylaner, Serdar; Gokben, Sarenur; Tekgul, Hasan; Serdaroglu, GulÖğe Fenestration methods for Sylvian arachnoid cysts-endoscopy or microsurgery(Springer, 2012) Turhan, Tuncer; Ersahin, Yusuf; Akinturk, Nevhis; Mutluer, SaffetIntroduction Two different approaches to fenestration, endoscopic and microsurgical, are in use for Sylvian arachnoid cysts (SACs), the most frequent among intracranial arachnoid cysts. We presented the clinical data and compared our results, with regard to technique and clinical success, with either microsurgical or neuroendoscopic fenestration of SACs. Materials and methods Twenty-nine patients who subjected to cysto-cisternostomy by the same team, using either of the two methods, were studied retrospectively. Results Thirteen patients underwent microsurgery, and 16 had endoscopic cysto-cisternostomy. No reoperation was needed in either of these groups, i.e., full clinical and radiological success was achieved in both. The complication rate was 23% in the microsurgery patients and 47% in the endoscopic surgery group, with no statistically significant difference. Conclusions No relevant differences between the two methods are seen either in the published data or in our results. Adding our results to the published data, both techniques were reviewed in a discussion of the one that allows a better controlled or safer fenestration. We conclude that endoscopic fenestration of SACs is not superior to microsurgical cyst fenestration, and the latter seems safer.Öğe The first step of patient-specific design calvarial implant: A quantitative analysis of fresh parietal bones(Springer, 2018) Govsa, Figen; Celik, Servet; Turhan, Tuncer; Sahin, Volkan; Celik, Meral; Sahin, Korhan; Ozer, Mehmet Asim; Kazak, ZuhalBackgroundAccurate knowledge of the fracture of cranial bone can provide insight into the prevention of skull fracture injuries and help aid the design of energy-absorbing head protection systems and safety helmets. When cranial bone needs to be removed or is lost, subsequent reconstruction of the defect is necessary to protect the underlying brain, or correct esthetic deformities, or both. Ideal reconstruction of defected bone is possible utilizing a biocompatible implant with a bone-like design individualized for the specific patient. The purpose of this study is to investigate the anatomical and mechanical characteristics of fresh frozen human parietal bones and determine compliance of polylactic acid-based personalized three-dimensional implants in terms of mechanical properties in order to replace such defective bones.MethodsParietal bone specimens were extracted from 19 fresh frozen cadavers. Morphological parameters of individual bone specimens were measured using Image J software. Three-point bend tests were performed to extract Young's modulus and tensile strength of the specimens from the measured force and displacement data by modeling the bone specimens as curved linear elastic beams. Also, three-point bend tests were performed to polylactic acid-based three-dimensional replicas mimicking geometry of the bone specimens in order to determine whether the material's Young's modulus and tensile strength properties comply with parietal bones.ResultsEntire fresh parietal specimens were observed to be comprised of a three-layered structure: external layers consisting of compact, high-density cortical bone and the central layer consisting of low-density, irregularly porous bone structure. Mean thickness of three-layered structure was 6.251.46mm. Mean Young's modulus and tensile strength of the specimens were 1.401.34GPa and 44.56 +/- 21.94MPa, respectively where no statistically significant differences among genders were detected (p>0.05). Mean Young's modulus and tensile strength of the polylactic acid-based three-dimensional implants mimicking geometry of the bone specimens were 1.8 +/- 0.7GPa and 72.8 +/- 2.5MPa, respectively.ConclusionsPolylactic acid-based three-dimensional implants can be considered as acceptable candidates for temporary replacement of parietal defects in terms of mechanical properties.Level of Evidence: Not ratable.Öğe Hidrosefali ve beyin tümörlerinde endoskopik cerrahinin geliştirilmesi(Ege Üniversitesi, 2016) Turhan, Tuncer; Turhan, TuncerAraştırma Projesi elektronik ortamda bulunmaktadır.;Obstrüktif hidrosefali tedavisinde endoskopik üçüncü ventrikülostomi (E3V), kliniğimizde son 20 yıldır giderek daha fazla kullanılmaktadır. Bu çalışmanın amacı, düşük E3V başarı oranı ile demografik ve etyolojik verilerin ilişkisini araştırmaktır. Çalışmaya toplam 280 hasta kabul edilmiştir. Hastalar yaş gruplarına göre sınıflandırılmışlardır ( 5 gruba ayrılmıştır: 0-1 ay, 1-6 ay, 6-12 ay, 1-18 yaş, erişkin). E3V başarı oranı, 0-1 ay grubunda % O; 1-6 ay grubunda % 28.6, 6-12 ay grubunda % 28.6, 1-18 yaş grubunda % 73.9, erişkin yaş grubunda % 85.8, tüm çalışma grubunda ise % 70.5 bulunmuştur. Küçük çocuklarda, E3V'nin yüksek başarısızlık oranları göstermesinden ve yaşın E3V başarısını etkilediğinden sıkça bahsedilmektedir. Bu geniş hasta grubundaki sonuçlar da özellikle 0-6 ay arasında endoskopik girişimin başarı oranının istatistiksel olarak düşük olduğunu desteklemektedir.Öğe Ictal urinary urge: localization and lateralization value in a pediatric case(Springer, 2015) Yilmaz, Sanem; Gokben, Sarenur; Turhan, Tuncer; Serdaroglu, Gul; Tekgul, HasanBackground Ictal urinary urge is a rare autonomic symptom usually lateralizing to the non-dominant hemisphere and localizing to the temporal lobe. A 12-year-old boy was referred with desire to void and contraction of the left arm. The history of the case revealed tickling and an unpleasant rising feeling in the stomach and sense of fear lasting for 1 year. He had been evaluated and treated several times with the diagnosis of gastroesophageal reflux and cystitis. His cranial MRI displayed an intra-axial mass formation on the right temporal lobe. Pathological findings were consistent with a low-grade glial mass. Ictal urinary urge has a considerable value both for localization and lateralization of seizures.Öğe The identification of risk factors and outcomes of cerebrospinal fluid shunt infections caused by carbapenem-resistant gram-negative bacteria in children: a retrospective cohort(Amer Assoc Neurological Surgeons, 2024) Ozenen, Gizem Guner; Bal, Zumrut Sahbudak; Bolat, Elif; Umit, Zuhal; Bilen, Nimet M.; Arslan, Sema Yildirim; Turhan, TuncerOBJECTIVE Cerebrospinal fluid (CSF) shunt infections caused by gram-negative bacteria are difficult to treat given the limited treatment options and the emergence of carbapenem-resistant (CR) strains. This study aimed to evaluate the demographic and clinical characteristics of children with CSF shunt and external ventricular drain (EVD) infections caused by gram-negative bacteria, to identify the risk factors for acquiring CR CSF shunt infections, and to report on the clinical outcomes of these infections. METHODS A retrospective cohort study was designed to evaluate pediatric patients with CSF shunt and EVD infections caused by gram-negative bacteria between January 2013 and February 2023. RESULTS A total of 64 episodes in 50 patients were evaluated. There were 45 (70.3%) CSF shunt infections and 19 (29.7%) EVD infections. The median (range) ages were 1.4 years (9 months-17.5 years) for CSF shunt infection patients and 4.2 years (1 month-17 years) for EVD infection patients. The most common isolated gram-negative bacteria species in CSF shunt infections were Pseudomonas spp. (12, 26.7%), followed by Escherichia coli (11, 24.4%), Klebsiella pneumoniae (9, 20%), and Enterobacter cloacae (5, 11.1%). In EVD infections, the most common isolated gram-negative bacteria species were Acinetobacter spp. (6, 31.6%), followed by Pseudomonas spp. (4, 21.1%) and E. coli (3, 15.8%). The carbapenem resistance rate was 26.3% (n = 5) in EVD infections and 26.2% (n = 11) in CSF shunt infections. When risk factors for carbapenem resistance were evaluated for CSF shunt infections, prior carbapenem treatment and a prolonged hospital stay > 7 days were risk factors for the CR group (p = 0.032 and p = 0.042, respectively). In definitive treatment, colistin was statistically more commonly used in the CR group (p = 0.049). When outcomes were evaluated, the 30-day mortality rate (18.2% vs 0%) was higher in the CR group, without a significant difference (p = 0.064). CONCLUSIONS A prolonged hospital stay > 7 days and prior carbapenem exposure within 30 days were associated with CR shunt infections caused by gram-negative bacteria.Öğe Indirect Bypass Procedures for Moyamoya Disease in Pediatric Patients(Turkish Neurosurgical Soc, 2011) Turhan, Tuncer; Ersahin, YusufAIM: Many direct and indirect surgical intervention methods have been defined for the treatment of moyamoya disease. Indirect surgical procedures have been increasingly used. In this study, indirect surgical intervention methods especially used in combination with pial synangiosis were assessed together with other indirect methods. MATERIAL and METHODS: 11 patients who were treated with an indirect bypass procedures at our clinic and followed for at least three years were retrospectively examined. 19 surgical interventions were performed for 18 patient hemispheres pertaining to these patients. 4 indirect surgical revascularization methods were used for three patient hemispheres. On the other hand, indirect procedures combined with pial synangiosis were applied in 11 operations. In addition, the "multiple burr-hole surgery" method was used in 4 four operations performed for two patients. RESULTS: The clinical success rate was 66.6% for patients where the techniques were applied with pial synangiosis. No new ischemic or hemorrhagic attack was observed during the follow-up period in any of these patients in this series. CONCLUSION: Pial synangiosis is a modification that Increases the success rate of indirect surgical methods. In addition, high success rates have been reported in recent publications related to multiple burr-hole surgery. This method is a candidate choice of surgical intervention for selected patients.
