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Börekci A, Kuru Bektaşoğlu P, Ramazanoğlu AF, Hazneci J, Gürer B, Hakan T, Çelikoğlu E. Surgical Management Thoracolumbar Fractures in Patients with Ankylosing Spondylitis: Technical Note with Case Series. World Neurosurg 2023; 176:3-9. [PMID: 37084846 DOI: 10.1016/j.wneu.2023.04.054] [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: 03/14/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVE Ankylosing spondylitis (AS) is a chronic inflammatory joint disease. Complications such as traumatic spinal fractures are mostly caused by hyperextension and are unstable. We report the cases of 5 patients with AS surgically treated for thoracolumbar fractures. METHODS AND RESULTS We shared our experience of posterior stabilization surgery performed for the treatment of thoracolumbar fractures after traumas such as fall-accident in patients with AS. Patients were all men, and their ages were between 52 and 77 years. The first 3 patients woke up with neurologic deficits and were managed surgically under general anesthesia. We managed the last 2 patients with unilateral short-level stabilization under local anesthesia followed by bilateral long-level stabilization under general anesthesia. No neurologic deterioration was found in the postoperative examination of these 2 patients. We assume that the reason for neurologic deterioration after general anesthesia is the relaxation of muscles. All 3 columns of the spine are affected in patients with AS and the stability is provided by the tone of the muscles around the spine. CONCLUSIONS To prevent postoperative neurologic complications after the surgical treatment of traumatic hyperextension thoracic and lumbar fractures in patients with AS, we recommend securing the fracture level with unilateral short-level stabilization under local anesthesia and then completing the operation with general anesthesia.
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Affiliation(s)
- Ali Börekci
- Department of Neurosurgery, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | | | - Ali Fatih Ramazanoğlu
- Department of Neurosurgery, University of Health Sciences, Umraniye Education and Research Hospital, Istanbul, Turkey
| | - Jülide Hazneci
- Department of Neurosurgery, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - Bora Gürer
- Department of Neurosurgery, Istinye University Faculty of Medicine, Istanbul, Turkey
| | - Tayfun Hakan
- Department of Neurosurgery, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - Erhan Çelikoğlu
- Department of Neurosurgery, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
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Aydın SO, Etli MU, Sarikaya C, Köylü RC, Varol E, Ramazanoğlu AF, Kayalar AE, Şerifoğlu L, Yaltirik K, Naderi S. Spinal Schwannomas: A Proposal for a New Classification to Aid Surgical Planning. J Neurol Surg A Cent Eur Neurosurg 2023. [PMID: 36914156 DOI: 10.1055/a-2053-2901] [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: 03/14/2023]
Abstract
Background The treatment of spinal schwannomas, which is the most common nerve sheath tumor, is total microsurgical resection. The localization, size and relationship with the surrounding structures of these tumors are crucial in terms of preoperative planning. A new classification method is presented in this study for the surgical planning of spinal schwannoma. Methods All patients who underwent surgery for spinal schwannoma between 2008 and 2021 were reviewed retrospectively, along with radiological images, clinical presentation, surgical approach, and postoperative neurological status. Results A total of 114 patients, 57 male, and 57 females were included in the study. Tumor localizations were cervical in 24 patients, cervicothoracic in one patient, thoracic in 15 patients, thoracolumbar in eight patients, lumbar in 56 patients, lumbosacral in two patients, and sacral in eight patients. All tumors were divided into seven types according to the classification method. Type 1 and Type 2 groups were operated on with a posterior midline approach only, Type 3 tumors were operated on with a posterior midline approach and extraforaminal approach, and Type 4 tumors were operated on with only an extraforaminal approach. While the extraforaminal approach was sufficient in type 5 patients, partial facetectomy was required in 2 patients. Combined surgery including hemilaminectomy and extraforaminal approach was performed in the type 6 group. A posterior midline approach with partial sacrectomy/corpectomy was performed in Type 7 group. Conclusion Effective treatment of spinal schwannoma depends on preoperative planning, which includes correctly classifying tumors. In this study, we present a categorization scheme that covers bone erosion and tumor volume for all spinal localizations.
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Affiliation(s)
- Serdar Onur Aydın
- Department of Neurosurgery, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Umut Etli
- Department of Neurosurgery, Siverek State Hospital, Sanliurfa, Turkey
| | - Caner Sarikaya
- Department of Neurosurgery, Sivas State Hospital, Sivas, Turkey
| | - Reha Can Köylü
- Neurosurgery, Sancaktepe Şehit Prof Dr Ilhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Eyüp Varol
- Department of Neurosurgery, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Ali Fatih Ramazanoğlu
- Department of Neurosurgery, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Ali Erhan Kayalar
- Neurosurgery, Umraniye Egitim Ve Arastirma Hastanesi, Istanbul, Turkey
| | - Luay Şerifoğlu
- Neurosurgery, Umraniye Egitim Ve Arastirma Hastanesi, Istanbul, Turkey
| | - Kaan Yaltirik
- Department of Neurosurgery, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Sait Naderi
- Neurosurgery, Istanbul Brain and Spine Center, Istanbul, Turkey
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Sarıkaya C, Ramazanoğlu AF, Yaltırık CK, Etli MU, Önen MR, Naderi S. Short-Term Results of Simpson Grade 2 Resection in Spinal Meningiomas. World Neurosurg 2023; 171:e792-e795. [PMID: 36587895 DOI: 10.1016/j.wneu.2022.12.115] [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] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 12/27/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Spinal meningiomas are benign and slow-growing intradural tumors. Surgery is the choice of treatment. In this retrospective study, results of minimally invasive Simpson grade 2 resection and its impact on recurrence in 44 spinal meningiomas are reviewed. METHODS Clinical data of 44 cases who underwent surgery for spinal meningiomas between 2010 and 2020 have been reviewed retrospectively. Demographics, preoperative and postoperative clinical states, pathologic type, location of the meningioma relative to the spinal cord, resection amount of the tumor according to Simpson's grading scale, postoperative complications, recurrence rate, and correlation between preoperative and intraoperative data and recurrence were analyzed. RESULTS The tumor was located in the thoracic spine in 31 cases, in the cervical spine in 12 cases, and in the lumbar spine in one case. Dural attachment of tumor was ventral to the spinal cord in 15 cases, lateral to the spinal cord in 15 cases, and posterior to the spinal cord in 14 cases. All cases underwent microsurgical Simpson grade 2 resection. Two cases were recurrent and reoperated. Recurrences were observed in cases younger than 18 years old, in cervical spines and in cases with long dural tails. CONCLUSIONS Simpson grade 2 resection is safe and effective in spinal meningiomas. Patients younger than 18 year old, and those with cervical location and long dural tail may be under risk of recurrence after Simpson grade 2 resection.
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Affiliation(s)
- Caner Sarıkaya
- Department of Neurosurgery, Sivas State Hospital, Sivas, Turkey.
| | - Ali Fatih Ramazanoğlu
- Department of Neurosurgery, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Cumhur Kaan Yaltırık
- Department of Neurosurgery, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Mustafa Umut Etli
- Department of Neurosurgery, Siverek State Hospital, Şanlıurfa, Turkey
| | - Mehmet Reşid Önen
- Department of Neurosurgery, VM Medical Park Maltepe Hospital, İstanbul, Turkey
| | - Sait Naderi
- Department of Neurosurgery, İstanbul Brain and Spine Center, İstanbul, Turkey
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Aydın SO, Etli MU, Köylü RC, Varol E, Yaltırık CK, Ramazanoğlu AF. Factors Associated with Nontraumatic Spontaneous Subdural Hematomas in Pediatric Patients. Neuropediatrics 2022. [PMID: 35793697 DOI: 10.1055/a-1893-2559] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE In our study, we aimed to summarize the etiology of subdural hematoma that was not traumatic and required operation in pediatric patients. The subdural hematoma characteristics, possible etiologies, and treatment, as well as the patient outcomes, were analyzed. METHODS A retrospective examination was made of pediatric patients with subdural hematoma who were operated on at Ümraniye Training and Research Hospital. Patients with a history of trauma were excluded. Data on patient sex, age, bleeding location, type of hematoma based on computed tomography imaging, surgical treatment, presenting symptoms, presence of comorbidities, Glasgow Coma Scale, thrombocyte counts, and international normalized ratio values were recorded. RESULTS Of the 19 patients included in the study, 4 were female and 15 were male. Their ages ranged between 0 and 15 (mean = 5.84) years. In 57.8% of the patients, comorbidities, including acute myeloid leukemia, a history of shunt operation, epilepsy, mucopolysaccharidosis, known subdural effusion, autism, coagulopathy, ventricular septal defect/tetralogy of Fallot, cerebrospinal fluid leakage after baclofen pump administration, Marfan's syndrome, and late neonatal sepsis were present, while 21% had arachnoid cysts and 21% had no reported comorbidities. CONCLUSION This study suggests that, in pediatric patients with subdural hematoma with an amount of bleeding requiring surgical management, any underlying comorbidities should be investigated regardless of the presence of a history of trauma. While investigating systemic diseases, special attention should be paid to the presence of arachnoid cysts or disruption in cerebrospinal fluid dynamics along with a history of hematologic diseases.
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Affiliation(s)
- Serdar Onur Aydın
- Department of Neurosurgery, Health Sciences University, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Umut Etli
- Department of Neurosurgery, Health Sciences University, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Reha Can Köylü
- Department of Neurosurgery, Health Sciences University, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Eyüp Varol
- Department of Neurosurgery, Health Sciences University, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Cumhur Kaan Yaltırık
- Department of Neurosurgery, Health Sciences University, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Ali Fatih Ramazanoğlu
- Department of Neurosurgery, Health Sciences University, Ümraniye Training and Research Hospital, Istanbul, Turkey
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Fatih Ramazanoğlu A, Sarıkaya C, Umut Etli M, Kaan Yaltırık C, Reşid Önen M, Naderi S. Results of percutaneous cervical vertebroplasty using an anterolateral approach for cervical spine tumors. AOTT 2022; 56:268-271. [PMID: 35968618 PMCID: PMC9612668 DOI: 10.5152/j.aott.2022.22035] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Objective: The aim of this study was to report the results of percutaneous vertebroplasty in managing symptomatic osteolytic cervical spine tumors. Methods: This study comprised a retrospective examination of patients who received percutaneous vertebroplasty between 2008 and 2020 for the treatment of tumor-induced symptomatic cervical vertebra involvement. The study summarized the demographics, vertebral levels, pain control rates, clinical results, and complications of percutaneous vertebroplasty using an anterolateral approach. Results: The study sample consisted of 6 female and 2 male patients aged between 20 and 56 (mean = 41.37) years. Tumors were located at C2 in 6 cases, at C3 in 1 case, and at C5 in another. The mean volume of poly (methyl methacrylate) injected was 1.5 mL (range: 1-2 mL). Biopsy results showed the presence of metastasis in 5 cases and plasmacytoma in 3. No postoperative complications or mortality were observed after the procedure. Preoperative mean 7.75 visual analog scale score decreased to 2.62. Pain control was reported to be 66.2%. Conclusion: Anterolateral cervical vertebroplasty seems to be a safe, effective, and helpful therapeutic alternative for the treatment of cervical spine tumors. It reduces the risk of infection compared to the transoral method. Level of Evidence: Level IV, Therapeutic Study
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Affiliation(s)
- Ali Fatih Ramazanoğlu
- Department of Neurosurgery, Health Sciences University, Ümraniye Training and Research Hospital, İstanbul, Turkey
- Corresponding author:Ali Fatih Ramazanoğlu
| | - Caner Sarıkaya
- Clinic of Neurosurgery, Sivas State Hospital, Sivas, Turkey
| | - Mustafa Umut Etli
- Department of Neurosurgery, Health Sciences University, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Cumhur Kaan Yaltırık
- Department of Neurosurgery, Health Sciences University, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Reşid Önen
- Department of Neurosurgery, VM Medical Park Maltepe Hospital, İstanbul, Turkey
| | - Sait Naderi
- Department of Neurosurgery, İstanbul Brain and Spine Center, İstanbul, Turkey
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Varol E, Etli MU, Avcı F, Ramazanoğlu AF, Aydın SO, Yaltırık CK, Naderi S. Can Posterior Midline Approach Provide Adequate Exposure for All Craniovertebral Junction Tumors? World Neurosurg 2022; 161:e482-e487. [DOI: 10.1016/j.wneu.2022.02.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 11/29/2022]
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Abstract
Endoscopic sinus surgery (ESS) may rarely be complicated by intracranial complications; the most common of them is a cerebrospinal fluid fistula. Pneumocephalus as a complication of ESS is quite rare. Here, we presented a unique case of tension pneumocephalus causing brain herniation as a complication of ESS, to whom emergent craniotomy was performed.
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Affiliation(s)
- Erhan Çelikoğlu
- Department of Neurosurgery, Neurosurgery Clinic, Ministry of Health, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - Jülide Hazneci
- Department of Neurosurgery, Neurosurgery Clinic, Ministry of Health, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - Ali Fatih Ramazanoğlu
- Department of Neurosurgery, Neurosurgery Clinic, Ministry of Health, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
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