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Cekic E, Pinar E, Pinar M, Dagcinar A. Deep Learning-Assisted Segmentation and Classification of Brain Tumor Types on Magnetic Resonance and Surgical Microscope Images. World Neurosurg 2024; 182:e196-e204. [PMID: 38030068 DOI: 10.1016/j.wneu.2023.11.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE The primary aim of this research was to harness the capabilities of deep learning to enhance neurosurgical procedures, focusing on accurate tumor boundary delineation and classification. Through advanced diagnostic tools, we aimed to offer surgeons a more insightful perspective during surgeries, improving surgical outcomes and patient care. METHODS The study deployed the Mask R-convolutional neural network (CNN) architecture, leveraging its sophisticated features to process and analyze data from surgical microscope videos and preoperative magnetic resonance images. Resnet101 and Resnet50 backbone networks are used in the Mask R-CNN method, and experimental results are given. We subsequently tested its performance across various metrics, such as accuracy, precision, recall, dice coefficient (DICE), and Jaccard index. Deep learning models were trained from magnetic resonance imaging and surgical microscope images, and the classification result obtained for each patient was combined with the weighted average. RESULTS The algorithm exhibited remarkable capabilities in distinguishing among meningiomas, metastases, and high-grade glial tumors. Specifically, for the Mask R-CNN Resnet 101 architecture, precision, recall, DICE, and Jaccard index values were recorded as 96%, 93%, 91%, and 84%, respectively. Conversely, for the Mask R-CNN Resnet 50 architecture, these values stood at 94%, 89%, 89%, and 82%. Additionally, the model achieved an impressive DICE score range of 94%-95% and an accuracy of 98% in pathology estimation. CONCLUSIONS As illustrated in our study, the confluence of deep learning with neurosurgical procedures marks a transformative phase in medical science. The results are promising but underscore diverse data sets' significance for training and refining these deep learning models.
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Affiliation(s)
- Efecan Cekic
- Department of Neurosurgery, Polatli Duatepe State Hospital, Ankara, Turkey.
| | - Ertugrul Pinar
- Department of Neurosurgery, Private Pendik Yuzyil Hospital, İstanbul, Turkey
| | - Merve Pinar
- Department of Computer Engineering, Marmara University, İstanbul, Turkey
| | - Adnan Dagcinar
- Department of Neurosurgery, Marmara University, İstanbul, Turkey
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Harman F, Oglin V, Yilmaz MO, Orhun O, Baran O, Boyukyilmaz S, Gezercan Y, Dalbayrak S, Dagcinar A. Different C2 screw placement techniques with mobilization of the vertebral artery in high-riding vertebral artery cases: Cadaver dissection. J Craniovertebr Junction Spine 2023; 14:341-345. [PMID: 38268685 PMCID: PMC10805154 DOI: 10.4103/jcvjs.jcvjs_73_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/20/2023] [Indexed: 01/26/2024] Open
Abstract
Objective In neurosurgery, posterior approaches intended at the craniovertebral junction are frequently used. The most popular procedures for treating upper cervical instability are C1 lateral mass, C2 pedicle, and C1-C2 transarticular screw stabilization. Due to their proximity to neural structures and the presence of the high-riding vertebral artery (VA), these techniques are complicated. The risk of VA damage can be decreased by mobilizing the VA. Using cadaveric specimens in this study was aimed to demonstrate C2 pedicle and C1-C2 transarticular screw placement with VA mobilization and a novel C2 inferior corpus screw placement technique. Methods In this study, twelve adult cadaveric specimens and two adult dry cadaveric C2 bones were used with the permission and decision of the University Research Ethics Committee. Colored silicone was injected into the arteries and veins of these twelve cadaveric specimens. Then, muscle dissection was performed stepwise, and the C2 vertebrae of the cadavers were revealed with a surgical microscope. Each specimen and entire stages of the dissections were recorded photographically. After cadaver dissections, screw placement was performed with three different techniques. Finally, radiological imaging was done with fluoroscopy. Results After dissection, the lateral mass of the C2 vertebra was observed, and lateral to it, the transverse process and foramen were detected with the help of a hook. Next, the posterior wall of the VA groove was removed using a 1 mm thin plate Kerrison rongeur until the VA loop could partially be observed the VA. This enables us to find the top of the loop of the VA and mobilize it inferiorly using a dissector. Following this step, the C1-2 transarticular, C2 pedicle, and the novel C2 inferior corpus screw placement can be performed safely by directly visualizing the artery. Conclusions Due to the nearby neurologic and vascular structures, placing the C2 pedicle and C1-2 transarticular screw is a challenging procedure, especially in high-riding VA cases. However, it is possible to place the C2 pedicle, C1-2 transarticular, and novel C2 inferior corpus screw after the mobilization of the VA. This study aimed to show all of them together on a cadaver for the first time, to understand the anatomy of the C2 vertebra, and to use screw placement techniques to minimize the risk of complications.
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Affiliation(s)
- Ferhat Harman
- Department of Neurosurgery, Marmara University Faculty of Medicine, Adana, Turkey
- Department of Neurosurgery, Marmara University Institute of Neurological Sciences, Adana, Turkey
- Department of Neurosurgery, Division of Microneurosurgery, Marmara University Institute of Health Sciences, Adana, Turkey
| | - Volkan Oglin
- Department of Neurosurgery, Marmara University Faculty of Medicine, Adana, Turkey
| | - Mehmet Ozgur Yilmaz
- Department of Neurosurgery, University of Health Science, Istanbul Training and Research Hospital, Adana, Turkey
| | - Omer Orhun
- Medical Student, Acıbadem University, School of Medicine, Adana, Turkey
| | - Oguz Baran
- Department of Neurosurgery, Koc University Faculty of Medicine, Adana, Turkey
| | - Seyma Boyukyilmaz
- Department of Emergency Medicine, Marmara University Faculty of Medicine, Adana, Turkey
| | - Yurdal Gezercan
- Department of Neurosurgery, Adana City Training and Research Hospital, Adana, Turkey
| | - Sedat Dalbayrak
- Department of Neurosurgery, Okan University Faculty of Medicine, Istanbul, Turkey
| | - Adnan Dagcinar
- Department of Neurosurgery, Marmara University Faculty of Medicine, Adana, Turkey
- Department of Neurosurgery, Marmara University Institute of Neurological Sciences, Adana, Turkey
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Cekic E, Karagoz A, Sakar M, Senay RE, Akar KE, Bozkurt S, Dagcinar A. Langerhans cell histiocytosis located in the spheno-orbital bone and the pons: illustrative case. J Neurosurg Case Lessons 2023; 6:CASE22367. [PMID: 37548554 PMCID: PMC10555582 DOI: 10.3171/case22367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 06/07/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND This is a case of aggressive Langerhans cell histiocytosis (LCH) with an atypical intracranial location. OBSERVATIONS In this report, the authors present the diagnosis and treatment of a 12-year-old male patient diagnosed with LCH. The patient was admitted to the emergency department with left-sided facial palsy, and a solid lesion with mass effect in the pons was found. A biopsy was performed via suboccipital craniotomy, and the diagnosis was LCH. A chemotherapy regimen was started since the LCH sample was the resistant type. The patient showed improvement in his neurological deficit following treatment. LESSONS This rare localized and aggressive case's diagnosis process and treatment choices may apply to future cases.
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Affiliation(s)
| | | | | | | | - Kadriye Ebru Akar
- Pathology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Suheyla Bozkurt
- Pathology, Faculty of Medicine, Marmara University, Istanbul, Turkey
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Kirkgoz T, Abali S, Seker A, Gurpinar Tosun B, Eltan M, Helvacioglu D, Haliloglu B, Kaygusuz SB, Yavas Abali Z, Seven Menevse T, Bozkurt S, Ones T, Guran T, Dagcinar A, Bereket A, Turan S. Challenges in the Management of a 7-Year-Old Child with Thyrotropin-Secreting Pituitary Adenoma and the Review of the Literature. Horm Res Paediatr 2023; 96:527-537. [PMID: 36630941 DOI: 10.1159/000529070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 01/02/2023] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Thyrotropin-producing pituitary adenoma (TSHoma) is a very rare disease, representing less than 1% of the pituitary tumours and presenting with elevated thyroid hormones and normal/high TSH concentrations. CASE PRESENTATION A 7-year-old boy with nervousness was referred by his psychiatrist for elevated free T4, T3, and TSH levels. Initial evaluation revealed an elevated α-subunit. Pituitary magnetic resonance imaging (MRI) demonstrated a macroadenoma. The patient underwent a trans-sphenoidal tumour resection (TSS) which showed positive immunohistochemical staining for TSH, growth hormone, and prolactin in tumoral tissue. Euthyroidism was achieved for 1 year after TSS, then recurrence of tumour with elevated TSH and thyroid hormone levels necessitated a re-operation with TSS followed by gamma-knife radiosurgery. The euthyroid state was achieved and lasted for 2.5 years this time, but due to the recurrence, medical treatment had been commenced with cabergoline and octreotide. Euthyroidism was maintained for the last 4 years on monthly octreotide treatment. A repeat MRI demonstrated no pituitary mass, but a mass in the sphenoidal sinus had been detected. Removal of this mass by surgery did not achieve euthyroidism. 68Ga-DOTA-TATE positron emission tomography/computed tomography showed residual tissue extending from the pituitary region to the sphenoid sinus. The patient's bone age was advanced by 2 years at diagnosis which became 4 years in 1 year after the diagnosis and remained so throughout follow-up, leading to a final height of -3.3 SDS below his target height at the age of 16 years. CONCLUSION The diagnosis, treatment, and follow-up of TSHomas are challenging, and short stature due to accelerated bone maturation is a complication of paediatric TSHomas.
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Affiliation(s)
- Tarik Kirkgoz
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
| | - Saygin Abali
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
| | - Askin Seker
- Department of Neurosurgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Busra Gurpinar Tosun
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
| | - Mehmet Eltan
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
| | - Didem Helvacioglu
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
| | - Belma Haliloglu
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
| | - Sare Betul Kaygusuz
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
| | - Zehra Yavas Abali
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
| | - Tuba Seven Menevse
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
| | - Suheyla Bozkurt
- Department of Pathology, Marmara University School of Medicine, Istanbul, Turkey
| | - Tunc Ones
- Department of Nuclear Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Tulay Guran
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
| | - Adnan Dagcinar
- Department of Neurosurgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Abdullah Bereket
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
| | - Serap Turan
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
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Rzayev T, Gokce K, Gucyetmez S, Bozkurt S, Dagcinar A, Tokuc G, Yaman A, Bilgen H, Ozek E. Atypical Teratoid Rhabdoid Tumor in a Newborn: Can IVF Be a Risk Factor? Fetal Pediatr Pathol 2022; 41:665-669. [PMID: 33872133 DOI: 10.1080/15513815.2021.1913536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BackgroundIn recent years, with the widespread use of assisted reproductive technologies, questions have arisen regarding the possible relationship between these infertile parents with assisted conception procedures and childhood cancers. Case report: We present a 23-day-old newborn conceived by in vitro fertilization (IVF) with a 53 × 46 × 38 mm intracranial mass detected by magnetic resonance imaging on the 15th postnatal day. The mass, removed on 23rd postnatal day, was an Atypical Teratoid Rhabdoid Tumor (ATRT), WHO grade 4. Conclusions: As far as we know, this is the only neonatally detected ATRT. Further studies are needed to investigate whether there is a causal relationship between IVF and childhood cancers.
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Affiliation(s)
- Turkay Rzayev
- Division of Neonatology, Department of Pediatrics, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Kubra Gokce
- Division of Neonatology, Department of Pediatrics, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Safak Gucyetmez
- Division of Neonatology, Department of Pediatrics, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Suheyla Bozkurt
- Department of Pathology, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Adnan Dagcinar
- Department of Neurosurgery, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Gulnur Tokuc
- Division of Hematology and Oncology, Department of Pediatrics, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Akan Yaman
- Division of Neonatology, Department of Pediatrics, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Hulya Bilgen
- Division of Neonatology, Department of Pediatrics, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Eren Ozek
- Division of Neonatology, Department of Pediatrics, Marmara University Faculty of Medicine, İstanbul, Turkey
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Sakar M, Erdogan O, Bozkurt SU, Dagcinar A. Intermediate-grade meningeal melanocytoma in a 19 months old child with difficulties in differential diagnosis and management. Turk Neurosurg 2021; 32:166-170. [PMID: 34664706 DOI: 10.5137/1019-5149.jtn.34672-21.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Intermediate-grade meningeal melanocytomas (IGM) are rarely reported tumors and has not been reported in childhood yet. They are spaculated to have more agressive clinical behavior and their best management options has not been defined. Here we report a 19 months old child being the first case in English literature having IGM. Pre-operative diagnosis was confusing since patient history was unclear and radiological features resembled a growing skull fracture or a subtype of congenital parietal bone agenesis. An area of 5x7 cm dura was found to be dark grey and black in colour and excised but the operation was complicated with brain edema and swelling, and a second operation for reconstruction and dural repair was needed. Of the 16 patients reported in adults, 14 showed a high recurrence rate without adjuvan radiotherapy, and 2 did not showed recurrence with adjuvan radiotherapy. Our patient did not have adjuvan radiotherapy since he was just 19 months old at the time his diagnosis and did not show recurrence until now at 24 months of follow-up. Close monitoring with radiological imaging is of paramount importance.
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Eltan M, Alavanda C, Yavas Abali Z, Ergenekon P, Yalındag Ozturk N, Sakar M, Dagcinar A, Kirkgoz T, Kaygusuz SB, Gokdemir Y, Elcioglu HN, Guran T, Bereket A, Ata P, Turan S. A Rare Cause of Hypophosphatemia: Raine Syndrome Changing Clinical Features with Age. Calcif Tissue Int 2020; 107:96-103. [PMID: 32337609 PMCID: PMC7222149 DOI: 10.1007/s00223-020-00694-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 04/11/2020] [Indexed: 11/29/2022]
Abstract
Raine Syndrome (RS) is caused by biallelic loss-of-function mutations in FAM20C gene and characterized by hypophosphatemia, typical facial and skeletal features. Subperiosteal bone formation and generalized osteosclerosis are the most common radiological findings. Here we present a new case with RS. A 9-month-old male patient on a home-type ventilator was referred for hypophosphatemia. He was born with a weight of 3800 g to non-consanguineous parents. Prenatal ultrasound had demonstrated nasal bone agenesis. A large anterior fontanel, frontal bossing, exophthalmos, hypoplastic nose, high arched palate, low set ears, triangular mouth, and corneal opacification were detected on physical examination. Serial skeletal X-rays revealed diffuse osteosclerosis at birth which was gradually decreased by the age of 5 months with subperiosteal undermineralized bone formation and medullary space of long bone could be distinguishable with bone-within-a-bone appearance. At 9 months of age, hand X-ray revealed cupping of the ulna with loose radial bone margin with minimal fraying and osteopenia. Cranial computed tomography scan showed bilateral periventricular calcification and hydrocephalus in progress. The clinical, laboratory, and radiological examinations were consistent with RS. Molecular analyses revealed a compound heterozygous mutation in FAM20C gene (a known pathogenic mutation, c.1645C > T, p.Arg549Trp; and a novel c.863 + 5 G > C variant). The patient died due to respiratory failure at 17 months of age. This case allowed us to demonstrate natural progression of skeletal features in RS. Furthermore, we have described a novel FAM20C variant causing RS. Previous literature on RS is also reviewed.
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Affiliation(s)
- Mehmet Eltan
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
| | - Ceren Alavanda
- Department of Medical Genetics, Marmara University School of Medicine, Istanbul, Turkey
| | - Zehra Yavas Abali
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
| | - Pinar Ergenekon
- Department of Pediatric Chest Disease, Marmara University School of Medicine, Istanbul, Turkey
| | - Nilufer Yalındag Ozturk
- Department of Pediatric Intensive Care Unit, Marmara University School of Medicine, Istanbul, Turkey
| | - Mustafa Sakar
- Department of Pediatric Neurosurgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Adnan Dagcinar
- Department of Pediatric Neurosurgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Tarik Kirkgoz
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
| | - Sare Betul Kaygusuz
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
| | - Yasemin Gokdemir
- Department of Pediatric Chest Disease, Marmara University School of Medicine, Istanbul, Turkey
| | - Huriye Nursel Elcioglu
- Department of Pediatric Genetics, Marmara University School of Medicine, Istanbul, Turkey
| | - Tulay Guran
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
| | - Abdullah Bereket
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey
| | - Pinar Ata
- Department of Medical Genetics, Marmara University School of Medicine, Istanbul, Turkey
| | - Serap Turan
- Department of Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey.
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Gencer-Atalay K, Karadag-Saygi E, Mirzayeva S, Gokce I, Dagcinar A. Postural Stability in Children with High Sacral Level Spina Bifida: Deviations from a Control Group. J Mot Behav 2019; 52:676-686. [PMID: 31630669 DOI: 10.1080/00222895.2019.1676189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To assess static and dynamic postural stability changes in children with high sacral level spina bifida.Methods: Thirty-five children with high sacral level spina bifida and 35 age-matched healthy controls were enrolled. Their lower extremity muscle strengths and static and dynamic postural stability parameters were measured with the use of a dynamometer and the NeuroCom Balance Master® device, respectively. Functional gait and balance were evaluated using the five times sit-to-stand test (5STS) and the 6-minute walk test (6MWT). Spinal, hip, and ankle deformities of the patient group were measured by radiologic evaluation.Results: In comparison with controls, patients were found to have lower ankle dorsiflexion and plantar-flexion strength, increased 5STS duration, and decreased 6MWT distance while both static and dynamic postural stability parameters were significantly different. Bilateral ankle muscle strengths were found to be negatively correlated with postural stability parameters. The presence of hydrocephalus or meningomyelocele in the patient group was found to have negative effects on static postural stability.Conclusion: Static and dynamic postural stability is affected even in children with high sacral level spina bifida who are expected to have best condition in this patient population. The ankle muscle strength is the main factor influencing these changes.
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Affiliation(s)
- Kardelen Gencer-Atalay
- Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, Pendik, Istanbul, Turkey
| | - Evrim Karadag-Saygi
- Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, Pendik, Istanbul, Turkey
| | - Samaya Mirzayeva
- Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, Pendik, Istanbul, Turkey
| | - Ibrahim Gokce
- Department of Pediatric Nephrology, Marmara University School of Medicine, Pendik, Istanbul, Turkey
| | - Adnan Dagcinar
- Department of Neurosurgery, Marmara University School of Medicine, Pendik, Istanbul, Turkey
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Yakut N, Soysal A, Kepenekli Kadayifci E, Dalgic N, Yılmaz Ciftdogan D, Karaaslan A, Akkoc G, Ocal Demir S, Cagan E, Celikboya E, Kanik A, Dagcinar A, Yilmaz A, Ozer F, Camlar M, Turel O, Bakir M. Ventriculoperitoneal shunt infections and re-infections in children: a multicentre retrospective study. Br J Neurosurg 2018; 32:196-200. [DOI: 10.1080/02688697.2018.1467373] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | - Ahmet Soysal
- Marmara University School of Medicine, Istanbul, Turkey
| | | | - Nazan Dalgic
- Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | | | | | - Gulsen Akkoc
- Marmara University School of Medicine, Istanbul, Turkey
| | | | - Eren Cagan
- Bursa Şevket Yılmaz Training and Research Hospital, Bursa, Turkey
| | - Ezgi Celikboya
- Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Ali Kanik
- İzmir Tepecik Training and Research Hospital, Izmir, Turkey
| | | | - Adem Yilmaz
- Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Fusun Ozer
- İzmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Mahmut Camlar
- İzmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ozden Turel
- Bezmialem University School Of Medicine, Istanbul, Turkey
| | - Mustafa Bakir
- Marmara University School of Medicine, Istanbul, Turkey
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10
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Bozkurt SU, Dagcinar A, Tanrikulu B, Comunoglu N, Meydan BC, Ozek M, Oz B. Significance of H3K27M mutation with specific histomorphological features and associated molecular alterations in pediatric high-grade glial tumors. Childs Nerv Syst 2018; 34:107-116. [PMID: 29063957 DOI: 10.1007/s00381-017-3633-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 10/16/2017] [Indexed: 01/07/2023]
Abstract
PURPOSE Pediatric high-grade gliomas (pHGGs) constitute almost 15% of all childhood brain tumors. Recurrent mutations such as H3K27M mutation in H3F3A and HIST1H3B genes encoding histone H3 and its variants were identified in approximately 30% of pediatric glioblastomas. This study aimed to ascertain the morphological and molecular characteristics of pHGGs with H3K27M mutation. METHODS In total, 61 cases of pHGGs (anaplastic astrocytoma, 12; glioblastomas, 49) from four university hospitals were studied. The histomorphological features were examined and immunohistochemistry was performed to evaluate the mutation status of H3K27M, ATRX, IDH1, BRAF V600E, and p53 genes. RESULTS The study comprised 25 females and 36 males (age range, 1-18 years) with a clinical follow-up of up to 108 months. From the total, 31 patients were positive for H3K27M mutation located in the midline, mostly in the pons and thalamus. H3K27M mutation was commonly associated with ATRX loss (32.3%) and p53 (74.2%) immunoreactivity with a co-expression rate of 25.8%. While IDH1 mutation was not detected in pHGGs with H3K27M mutation, BRAFV600E mutation was rarely observed. Among the various histomorphological features, increased number of mitosis, increased Ki-67 proliferation index, and palisading and geographical necrosis along with small cell patterns were significantly associated with the H3K27M wild-type tumors. Focal infarct-like necrosis and pilomyxoid morphology was significantly associated with these tumors. CONCLUSION H3K27M mutation occurs exclusively in pHGGs arising from the midline and presents with varied histomorphological features ranging from low-grade pilomyxoid astrocytoma to highly pleomorphic glioblastoma along with ATRX loss and p53 mutations.
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Affiliation(s)
- Süheyla Uyar Bozkurt
- Department of Pathology, Marmara University Training and Research Hospital, Fevzi Cakmak Mah. Mimar Sinan Cad. No: 41 Ust Kaynarca Pendik, Istanbul, Turkey.
| | - A Dagcinar
- Department of Neurosurgery, Marmara University, Istanbul, Turkey
| | - B Tanrikulu
- Department of Neurosurgery, Acibadem University, Istanbul, Turkey
| | - N Comunoglu
- Department of Pathology, Cerrahpasa Faculty, Istanbul University, Istanbul, Turkey
| | - B C Meydan
- Department of Pathology, Ondokuzmayis University, Samsun, Turkey
| | - M Ozek
- Department of Neurosurgery, Acibadem University, Istanbul, Turkey
| | - B Oz
- Department of Pathology, Cerrahpasa Faculty, Istanbul University, Istanbul, Turkey
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Erdogan H, Altun A, Kuruoglu E, Kaya AH, Dagcinar A. Difficulties of Distal Catheter Insertion of Ventriculoatrial Shunting in Infants and Little Children. Turk Neurosurg 2017. [PMID: 29091252 DOI: 10.5137/1019-5149.jtn.21304-17.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM Ventriculoatrial (VA) shunting is a well-described cerebrospinal fluid diversion method for the treatment of hydrocephalus. However, it may be very challenging in infants and little children because of atrial catheter placement difficulties. This study aimed to create an algorithm to solve problems faced during open surgical procedures based on the present authors' experience. MATERIAL AND METHODS We conducted a retrospective analysis on 18 infants and children who underwent VA shunt insertion at the Department of Neurosurgery, Ondokuz Mayıs University School of Medicine Hospital between 2005 and 2012. Complications, clinical outcomes, revisions, and solutions for overcoming distal catheter placement difficulties were evaluated. RESULTS Twenty-six VA shunt operations were performed in 18 patients. Six patients required eight VA shunt revisions. VA shunting was primarily performed from the internal jugular, facial, cephalic, and subclavian veins to the right atrium. In revision procedures, the internal jugular, cephalic, and subclavian veins were used. CONCLUSION VA shunting in infants and little children requires careful surgical techniques. Neurosurgeons should necessarily have an appropriate strategy for VA shunting considering the complications and revisions. Our results suggest open surgical solutions to overcome distal catheter placement difficulties in this age group.
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Affiliation(s)
- Hakan Erdogan
- Adatıp Hospital, Neurosurgery Clinic, Istanbul, Turkey
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Thomas DT, Yener S, Kalyoncu A, Uluc K, Bayri Y, Dagcinar A, Dagli T, Tugtepe H. Somatosensory evoked potentials as a screening tool for diagnosis of spinal pathologies in children with treatment refractory overactive bladder. Childs Nerv Syst 2017; 33:1327-1333. [PMID: 28342118 DOI: 10.1007/s00381-017-3393-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 03/17/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the usefulness of somatosensory evoked potential as a screening tool for spinal pathologies in patients with treatment refractory overactive bladder. METHODS This prospective study was performed between January 2011 and January 2014. Children >5 years old with treatment refractory overactive bladder were enrolled after exclusion of anatomical and neurological causes of incontinence. All patients underwent urodynamic studies, spinal MRI, and somatosensory evoked potential (SEP). Sensitivity, specificity, PPV, and NPV were calculated for SEP. RESULTS Thirty-one children (average age 8.3 ± 2.9 years) were included in the study. SEP was abnormal in 13 (41.9%), and MRI was abnormal in 8 (25.8%) patients. SEP was found to have a sensitivity of 87.5%, a specificity of 73.9%, positive predictive value of 53.85%, and negative predictive value (NPV) of 94.4%. CONCLUSION In patients with treatment refractory OAB, SEP is an important tool for the screening of tethered cord/spinal pathologies. Our results suggest that a child with a normal SEP study in this group of patients may not require further investigation with MRI.
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Affiliation(s)
- David Terence Thomas
- Department of Pediatric Surgery, Maltepe University Faculty of Medicine, Istanbul, Turkey
| | - Sevim Yener
- Department of Pediatric Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Aybegum Kalyoncu
- Department of Pediatric Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Kayihan Uluc
- Department of Neurology, Marmara University School of Medicine, Istanbul, Turkey
| | - Yasar Bayri
- Department of Neurosurgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Adnan Dagcinar
- Department of Neurosurgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Tolga Dagli
- Division of Pediatric Urology, Department of Pediatric Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Halil Tugtepe
- Division of Pediatric Urology, Department of Pediatric Surgery, Marmara University School of Medicine, Istanbul, Turkey.
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Yakut N, Soysal A, Kadayifci EK, Dalgic N, Ciftdogan DY, Karaaslan A, Cagan E, Celikboya E, Kanik A, Dagcinar A, Yilmaz A, Ozer F, Camlar M, Turel O, Bakir M. Persistant High Cerebrospinal Fluid Protein May Be a Risk Factor for Ventriculoperitoneal Shunt Reinfection in Children. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Nurhayat Yakut
- Pediatric Infectious Diseases, Marmara University Medical Faculty, Istanbul, Turkey
| | - Ahmet Soysal
- Pediatric Infectious Diseases, Marmara University Medical Faculty, Istanbul, Turkey
| | | | - Nazan Dalgic
- Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey
| | | | - Ayse Karaaslan
- Pediatric Infectious Diseases, TC. Sağlık Bakanlığı Dr. Lütfi Kırdar Kartal EA Hastanesi, Istanbul, Turkey
| | - Eren Cagan
- Sevket Yilmaz Research and Training Hospital, Bursa, Turkey
| | - Ezgi Celikboya
- Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey
| | - Ali Kanik
- Tepecik Research and Training Hospital, Izmir, Turkey
| | - Adnan Dagcinar
- Neurosurgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Adem Yilmaz
- Neurosurgery, Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey
| | - Fusun Ozer
- Neurosurgery, Tepecik Research and Training Hospital, Izmir, Turkey
| | - Mahmut Camlar
- Neurosurgery, Tepecik Research and Training Hospital, Izmir, Turkey
| | - Ozden Turel
- Pediatric Infectious Diseases, Bezmialem University School of Medicine, Istanbul, Turkey
| | - Mustafa Bakir
- Pediatric Allergy and Immunology, Marmara University School of Medicine, Istanbul, Turkey
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Yakut N, Kadayifci EK, Karaaslan A, Atici S, Akkoc G, Ocal Demir S, Dagcinar A, Akbulut F, Soysal A, Bakır M. Braın abscess due to Streptococcus intermedius secondary to mastoiditis in a child. Springerplus 2015; 4:809. [PMID: 26722629 PMCID: PMC4689728 DOI: 10.1186/s40064-015-1608-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 12/13/2015] [Indexed: 11/13/2022]
Abstract
Background Brain abscess is a rare but serious, life-threatening infection in children. It may arise from parameningeal infections such as otitis media, sinusitis and mastoiditis. Case description A ten-year-old boy with the diagnosis of glycogen-storage disease and obesity was admitted to the emergency room with complaints of vomiting, decreased level of consciousness, imbalance on walking. On neurological examination, the patient was ataxic. His cranial magnetic resonance imaging (MRI) examination showed mastoiditis on the right side and 39 × 34 mm abscess formation with surrounding edema on the right cerebellar hemisphere. The patient underwent surgery to drain the abscess, microbiological samples were obtained and empirical antibiotic treatment with vancomycin and piperacillin–tazobactam were started. Postoperative cranial MRI examination showed that the lesion regressed 10 × 10 mm with a reduction in the edema. On the second week of the treatment, the antibiotics were switched to vancomycin and meropenem because of the relapsing fever. The therapy was continued for 6 weeks. A final MRI (after completing antibiotherapy) showed resolution of the cerebellar abscess. The child’s clinical condition improved and he was discharged without any sequelae. Discussion and evaluation Children with congenital heart disease and an immonocompromised state are particularly at risk. Streptococcus intermedius is usually a commensal microorganism in the normal flora of the mouth which can cause brain abscess rarely in children. Brain abscess induced mortality rates are still relatively high, even with the advancement of imaging technologies, the combination of surgical drainage and antimicrobial therapy. Conclusion This case is one of the few reported cases of cerebellar abscess caused by S. intermedius in an immunocompetent child, due to its low virulence, a rare occurence and timely management resulting in fully healed.
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Affiliation(s)
- Nurhayat Yakut
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University School of Medicine, Istanbul, Turkey
| | - Eda Kepenekli Kadayifci
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University School of Medicine, Istanbul, Turkey
| | - Ayse Karaaslan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University School of Medicine, Istanbul, Turkey
| | - Serkan Atici
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University School of Medicine, Istanbul, Turkey
| | - Gulsen Akkoc
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University School of Medicine, Istanbul, Turkey
| | - Sevliya Ocal Demir
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University School of Medicine, Istanbul, Turkey
| | - Adnan Dagcinar
- Department of Neurosurgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Fatih Akbulut
- Department of Neurosurgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Ahmet Soysal
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University School of Medicine, Istanbul, Turkey ; No 41, Fevzi Cakmak mahallesi, Ustkaynarca, Pendik, Istanbul, Turkey
| | - Mustafa Bakır
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University School of Medicine, Istanbul, Turkey
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Ulus A, Kuruoglu E, Ozdemir SM, Yapici O, Sensoy G, Yarar E, Kaya AH, Senel A, Dagcinar A. CSF hydrothorax: neither migration of peritoneal catheter into the chest nor ascites. Case report and review of the literature. Childs Nerv Syst 2012; 28:1843-8. [PMID: 22825420 DOI: 10.1007/s00381-012-1862-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 07/10/2012] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Complications of ventriculoperitoneal (V/P) shunt surgery are generally due to infection, or mechanical or dynamic dysfunction. Thoracic complications like cerebrospinal fluid (CSF) hydrothorax are rarely seen. PATIENT AND METHODS We present a CSF hydrothorax patient as a rare complication of V/P shunt surgery and review of the literature. The patient was a 7-month-old girl who had V/P shunt surgery for hydrocephalus. Six months after surgery, she was admitted to hospital with the complaint of cough. As the chest X-ray revealed hydrothorax, a chest tube was inserted. Although her shunt tip was in the abdominal cavity in shuntograms, positive beta-2 transferrin in liquid sample and Tc 99m cisternography proved that it was CSF. After we replaced her V/P shunt with a ventriculoatrial shunt, the liquid coming from the chest tube progressively diminished and disappeared, and her chest tube was removed. RESULTS There are 36 CSF hydrothorax cases, including the present case, in the literature. There is peritoneal catheter migration into the chest in 22 of them (61.1 %). Half of the remaining 14 cases (38.9 %) without catheter migration have also CSF ascites. But, in the other half (seven cases), there is neither catheter migration nor CSF ascites as in the present case. CONCLUSION CSF hydrothorax following V/P shunt surgery is a very rare complication that may cause serious respiratory distress. It is important to keep in mind that peritoneal catheter migration into the chest may or may not occur. Even ascites may not accompany CSF hydrothorax in a patient without peritoneal catheter migration.
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Affiliation(s)
- Aykan Ulus
- Department of Neurosurgery, Ondokuz Mayis University, Beyin ve Sinir Cerrahisi AD, 06153 Samsun, Turkey.
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Aydın ME, Kaya AH, Kopuz C, Demir MT, Corumlu U, Dagcinar A. Bilateral origin of superior cerebellar arteries from the posterior cerebral arteries, and clues to its embryologic basis. Anat Cell Biol 2011; 44:164-7. [PMID: 21829761 PMCID: PMC3145846 DOI: 10.5115/acb.2011.44.2.164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2010] [Revised: 04/15/2011] [Accepted: 04/19/2011] [Indexed: 12/05/2022] Open
Abstract
The superior cerebellar artery is the most consistent branch of the basilar artery and arises near the bifurcation of the basilar artery. A bilateral origin of the superior cerebellar arteries from the posterior cerebral arteries has been rarely reported in the literature. Reporting variations in brain vessels is important for neurosurgeons to safely and confidently treat pathologies in this region. We report on a specimen with a bilateral origin to the superior cerebellar artery from the posterior cerebral artery and discuss the embryogenesis of this rare variation.
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Affiliation(s)
- Mennan Ece Aydın
- Department of Anatomy, Medical Faculty, Ondokuz Mayıs University, Samsun, Turkey
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Abstract
As the use of instrumentation in spinal surgery has become common, the need for revision surgery has increased. During revision surgery one of the most difficult steps is removal of poly-axial pedicle screws, especially if no suitable revision set is available. We describe here an easy method for poly-axial screw removal. Leaving or placing a small piece of rod, attached firmly by a nut, tightens the head of the poly-axial screw. It can no longer move freely from the distal part of the screw and the screw can be removed by turning it counterclockwise with a big clamp or needle driver, which is available in almost every surgery set.
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Affiliation(s)
- A Ulus
- Ondokuz Mayis University, Neurosurgery, Samsun, Turkey.
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18
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Kaya AH, Ulus A, Bayri Y, Topal A, Gun S, Kandemir B, Dagcinar A, Senel A, Iyigun O. There are no estrogen and progesterone receptors in cerebral cavernomas. ACTA ACUST UNITED AC 2009; 72:263-5; discussion 265. [DOI: 10.1016/j.surneu.2008.09.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2008] [Revised: 08/25/2008] [Accepted: 09/17/2008] [Indexed: 11/30/2022]
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Konya D, Gercek A, Dagcinar A, Baykan N, Ozek MM. Prevention of brisk hyperactive response during selective dorsal rhizotomy in children with spasticity: isoflurane versus sevoflurane maintenance anesthesia. J Clin Neurosci 2008; 16:241-5. [PMID: 19103494 DOI: 10.1016/j.jocn.2008.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Revised: 02/09/2008] [Accepted: 02/12/2008] [Indexed: 11/17/2022]
Abstract
In children with spasticity, deep tendon reflexes are hyperactive and even stimulation of normal dorsal rootlets can produce exaggerated full-strength, single-twitch responses in the muscles they innervate. This phenomenon is called the brisk hyperactive response (BHR). The aim of this study was to compare the efficacy of 2 volatile anesthetics, isoflurane and sevoflurane, for suppressing the confounding effect of BHR during selective dorsal rhizotomy (SDR) in children with spasticity. The subjects were 54 consecutive children of American Society of Anesthesiology physical status III who were scheduled for SDR. After tracheal intubation, each child was randomly assigned to Group I (isoflurane; n=27) or Group S (sevoflurane; n=27). There was no significant difference between the mean operation times in Groups I and S (200+/-40 vs. 220+/-35 minutes, respectively; p=0.0559). Thirteen patients in Group I (48.1%) and 5 in Group S (18.5%) exhibited BHR during stimulation of the dorsal rootlets (odds ratio 4.086; p=0.0418). Three of these 18 patients (2 in Group I and 1 in Group S) experienced hypertension and tachycardia simultaneously with BHR (odds ratio 4.086; p=1.0). The results suggest that sevoflurane is more effective at preventing BHR and might be a better choice for anesthetic management of children with spasticity undergoing SDR.
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Affiliation(s)
- Deniz Konya
- Department of Neurosurgery, Marmara University, Institute of Neurological Sciences, Istanbul, Turkey
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20
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Güven A, Dagcinar A, Ceyhan M. Coexistence of craniovertebral junction stenosis with pancake kidney in an adolescent with acromesomelic dysplasia. J Pediatr Endocrinol Metab 2008; 21:941-2. [PMID: 19209615 DOI: 10.1515/jpem.2008.21.10.941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ayla Güven
- Department of Pediatric Endocrinology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey.
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Abstract
Primary meningeal osteosarcomas are rare tumors, with only 19 reported cases in the literature; only 4 of these, including the present case, are in pediatric patients. In this report, the authors present the case of an 8-year-old boy with a history of generalized tonic-clonic seizures who was found to harbor a meningeal osteosarcoma within the sylvian fissure. Initial working diagnoses included meningioma and glioma. After tumor enlargement and progressive symptoms, the patient underwent a large frontotemporal craniotomy and complete resection of the lesion, which recurred 6 and 12 months after the initial surgery and was surgically treated after each recurrence. The rarity of primary meningeal osteosarcomas can make their diagnosis difficult, and histopathological evaluation is mandatory for diagnosis. Because of their fast progression, they must be treated aggressively by means of surgery, chemotherapy, and radiotherapy.
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Affiliation(s)
- Adnan Dagcinar
- Department of Neurosurgery, Marmara University School of Medicine, Istanbul, Turkey
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Kaya AH, Dagcinar A, Celik F, Senel A. Simple technique for removing broken pedicular screw with plain and serviceable screwdriver. Eur Spine J 2008; 17:1116-8. [PMID: 18343957 DOI: 10.1007/s00586-008-0650-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2008] [Revised: 02/18/2008] [Accepted: 03/01/2008] [Indexed: 11/26/2022]
Abstract
Removing the broken pedicular screw after spinal hardware failure is usually problematic. A specially designed simple screwdriver and easy removal technique of broken pedicular screw with this screwdriver are described in this article.
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Affiliation(s)
- Ahmet H Kaya
- Department of Neurosurgery, Faculty of Medicine, Ondokuz Mayis University, Kurupelit, Samsun, Turkey.
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Dagcinar A, Konya D, Akakin A, Gercek A, Ozgen S, Pamir NM. Congenital dermal sinus of the cervical spine in an adult. J Clin Neurosci 2008; 15:73-6. [DOI: 10.1016/j.jocn.2006.05.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2006] [Revised: 05/11/2006] [Accepted: 05/16/2006] [Indexed: 11/25/2022]
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Kaya AH, Dagcinar A, Cebeci I, Senel A, Celik F. A training model head of plaster of Paris for stereotactic localization. Surg Neurol 2007; 68:544-6; discussion 546. [PMID: 17597190 DOI: 10.1016/j.surneu.2006.12.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2006] [Accepted: 12/21/2006] [Indexed: 05/16/2023]
Abstract
BACKGROUND A head model for experiencing stereotactic localization will supply familiarity with stereotactic instruments and self confidence for attempters of stereotaxy before real experience. METHOD Plaster of Paris was molded as a model head in a plastic ball. Then, it was partly chipped at its superior half, and metal pieces were inserted into those chipped surfaces. Later, the stereotactic frame was applied, and axial computed tomographic scanning was obtained. The metal pieces seen on scans were selected as targets, and their coordinates were calculated using the software of the stereotactic equipment. Lastly, the stereotactic needle was introduced with these coordinates for investigation of targeting. RESULTS The model of plaster of Paris head was very suitable for rigid frame fixation. The metal pieces in the model head were clearly observed on computed tomographic scans. The stereotactic biopsy needle introduced with the perviously calculated coordinates was always successful in true targeting. CONCLUSION This easily performed model head supplied us with familiarity with our stereotactic apparatus and convinced us for further attempts. This kind of model and more complicated ones may help for stereotaxy training in neurosurgery.
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Affiliation(s)
- Ahmet Hilmi Kaya
- Department of Neurosurgery, Ondokuz Mayis University, Faculty of Medicine, Samsun, Turkey.
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Dagcinar A, Hilmi Kaya A, Ali Taşdemir H, Kuruoglu E, Sabancilar Z, Sav A. A fourth ventricular ganglioneurocytoma representing with cerebellar epilepsy: a case report and review of the literature. Eur J Paediatr Neurol 2007; 11:257-60. [PMID: 17418600 DOI: 10.1016/j.ejpn.2007.02.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2006] [Revised: 02/12/2007] [Accepted: 02/13/2007] [Indexed: 10/23/2022]
Abstract
Fourth ventricular low-grade tumoral or dysplastic neuronal lesions have been reported as an epileptic focus for recently described cerebellar epilepsy in the form of repetitive and stereotyped attacks of hemifascial spasm, eye blinking, fascial movements, head deviation and dysautonomic manifestations. The case of a 3-month old infant having fourth ventricular mass with similar symptoms such as paroxysmal facial movements, eye blinking, eyelid contractions and abnormal head posture is reported in this article. After a few days of her admission, her attacks displayed a new form with altered consciousness and left limb jerks which were unresponsive to medical therapy. Following the surgical excision of the lesion 10 months ago, attacks disappeared and she is still seizure free. Histopathological diagnosis was ganglioneurocytoma. The seizures (which may be intractable in cerebellar epilepsy) are thought to have arisen from subcortical structures such as cerebellum, brain stem nuclei or the lesion itself. In the case of intractable episodes, surgical excision may prevent further seizures and help patients have a normal cognitive and motor development.
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Affiliation(s)
- Adnan Dagcinar
- Medical Faculty, Department of Neurosurgery, Ondokuz Mayis University, Kurupelit, Samsun, Turkey.
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Abstract
BACKGROUND Different retractors including high-technology products were proposed for neurosurgical interventions. The sponge, having characteristics of deformability and resistance to compression, might be an alternative retractor for the neurosurgical era. METHODS Sponge obtainable from the ordinary market was broken into pieces and sterilized by ethylene oxide. During intervention, the appropriate sponge pieces were applied inside the dissected sulci for the purpose of retraction. RESULTS The sponge pieces were easily applied and supplied optimal retraction during operations. Proximal application to the dissected sylvian fissure enabled the exposure of the inner distal part including the insular surface, whereas application between the frontobasal surface and the orbital roof provided satisfactory exposure of the suprachiasmatic area. The retraction capacity of the sponge was less than that of self-retaining Leyla retractors, but the postoperative appearance of cortical surfaces was fine without any bruising or hyperemia. CONCLUSION The sponge material, with its inner mechanical characteristics and ease of application like cotton pads, seems to be an alternative retractor in neurosurgical interventions, and these characteristic may inspire development of new high-technology retractors.
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Affiliation(s)
- Adnan Dagcinar
- Ondukuz Mayis University, Medical School, Department of Neurosurgery, Samsun, Turkey
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Abstract
Lumbar disc herniation very rarely occurs in adolescence. The aim of this study was to assess the radiological, clinical and surgical features and case outcomes for adolescents with lumbar disc herniation, and to compare with adult cases. The cases of 17 adolescents (7 girls and 10 boys, age range 13-17 years) who were surgically treated for lumbar disc herniation in our clinic between 1998 and 2003 were retrospectively reviewed. The mean follow-up time for these cases was 60 months. The collected histories revealed that 14 (82%) of the 17 cases involved trauma or intense sports activity. Low back pain was the most common complaint (15 cases, 88%). None of the 17 patients had major symptoms during follow-up, and most were engaged in intense sports or heavy work-related activities during this period. The main features of lumbar disc herniation in adolescents are different from those seen in adults. Careful assessment is vital to avoid misdiagnosis and prevent undesirable results from inappropriate surgery. When surgery is indicated and patients are carefully selected, the results of lumbar discectomy in adolescence can be satisfactory.
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Affiliation(s)
- Serdar Ozgen
- Department of Neurosurgery, Marmara University Faculty of Medicine, Istanbul, Turkey
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Konya D, Dagcinar A, Akakin A, Gercek A, Ozgen S, Pamir MN. Cervical meningocele causing symptoms in adulthood: case report and review of the literature. ACTA ACUST UNITED AC 2006; 19:531-3. [PMID: 17021419 DOI: 10.1097/01.bsd.0000211223.51436.0b] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Simple meningoceles are infrequent forms of dysraphism and are often benign. These lesions are usually associated with other congenital spinal anomalies, and are typically diagnosed in childhood. Most become symptomatic in childhood because of progressive spinal cord or nerve root tethering. This article describes the case of a 47-year-old man who presented with a sac in his posterior cervical region that had been leaking colorless fluid for 3 months. He was also having difficulty walking and complained of stiffness in his lower extremities. Cervical magnetic resonance imaging revealed a cystic mass in the region of the C4 to C5 laminae. Partial laminectomies were performed (lower portion C4 lamina, upper portion C5 lamina), the sac was totally excised, and tissue tethering the spinal cord were cut. There was no recurrence of symptoms in 12 months of follow-up. Although in cases where a cervical meningocele-myelomeningocele is detected at any time, early treatment is essential to eliminate the high risk of future neurological impairment. This is the first report of an untreated cervical meningocele manifesting symptoms in adulthood.
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Affiliation(s)
- Deniz Konya
- Department of Neurosurgery, Marmara University Faculty of Medicine, Istanbul, Turkey.
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Abstract
Diastematomyelia, or split cord malformation, a complete or incomplete sagittal division of the neural axis into halves, is seen in association with many other congenital anomalies. Among these anomalies, intradural spinal teratoma is extremely rare. Diastematomyelia is a well-recognized although unusual clinical syndrome in children, but it is rarely reported in the adult. The authors describe a 42-year-old man who presented with pain and distal left-leg weakness as well as neurogenic claudication for 1 month. The patient underwent radiological examinations, and diastematomyelia and an intradural lumbar teratoma were diagnosed. He underwent surgery and was followed for 1 year. This is the fourth case of an adult who simultaneously presented with diastematomyelia and an intradural teratoma.
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Affiliation(s)
- I Elmaci
- Department of Neurosurgery, Marmara University School of Medicine, Istanbul, Turkey.
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