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Çalış F, Şimşek AT, İnan NG, Topyalın N, Adam BE, Elias Ç, Aksu ME, Aladdam M, Gültekin G, Sorkun MH, Tez M, Balak N. Factors Affecting Turkish Medical Students' Pursuit of a Career in Neurosurgery: A Single Center Survey Study. World Neurosurg 2024:S1878-8750(24)00373-5. [PMID: 38460813 DOI: 10.1016/j.wneu.2024.02.155] [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: 12/08/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Statistics show that over the past two decades, even in high-income countries, fewer and fewer students have listed neurosurgery as their top career option. Literature on medical students' pursuit of neurosurgical careers in middle- and low-income countries are scarce. The aim of this research, conducted in Turkey with a middle-income economy, was to contribute insights relevant to medical education and neurosurgery across the world. METHODS A survey was conducted with a target sample of fourth-year (167 students), fifth-year (169 students), and sixth-year (140 students) medical students (476 in total) from the Medical School at Istanbul Medeniyet University in Turkey. The response rates of the fourth-, fifth-, and sixth-year students were 62% (104/167), 53% (90/169), and 50% (70/140), respectively (in total, 266, including 147 female and 119 male). RESULTS In terms of the genuine intention, only 2.5% of the men and 2.7% of the women were committed to specializing in neurosurgery. This study further revealed that possible reasons for these students' low motivation to specialize in neurosurgery were their beliefs that in neurosurgery, the physical and psychological demands were high, and the night shifts were intense, meaning they would not have a social life or spare time for their hobbies; that morbidity/mortality were high; and that financial incentives were insufficient, especially in public institutions. CONCLUSION Turkish medical students did not rank neurosurgery at the top of their career choices. Possible reasons for this are socioeconomic factors and the inadequate introduction of neurosurgery to medical students.
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Affiliation(s)
- Fatih Çalış
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Prof. Dr. SüleymanYalçın City Hospital, Istanbul, Türkiye
| | - Abdullah Talha Şimşek
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Prof. Dr. SüleymanYalçın City Hospital, Istanbul, Türkiye
| | | | - Nur Topyalın
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Prof. Dr. SüleymanYalçın City Hospital, Istanbul, Türkiye
| | - Baha E Adam
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Prof. Dr. SüleymanYalçın City Hospital, Istanbul, Türkiye
| | - Çimen Elias
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Prof. Dr. SüleymanYalçın City Hospital, Istanbul, Türkiye
| | - Muhammed Emin Aksu
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Prof. Dr. SüleymanYalçın City Hospital, Istanbul, Türkiye
| | - Mohammed Aladdam
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Prof. Dr. SüleymanYalçın City Hospital, Istanbul, Türkiye
| | - Güliz Gültekin
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Prof. Dr. SüleymanYalçın City Hospital, Istanbul, Türkiye
| | | | - Müjgan Tez
- Department of Statistics, Faculty of Arts and Sciences, Marmara University, Istanbul, Türkiye
| | - Naci Balak
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Prof. Dr. SüleymanYalçın City Hospital, Istanbul, Türkiye.
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Balak N. Letter to the Editor. An additional pitfall in the practice of neurosurgery: healthcare policies. J Neurosurg 2024:1-2. [PMID: 38306644 DOI: 10.3171/2023.11.jns232597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
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Şimşek AT, Baysal B, Adam BE, Çalış F, Topçam A, Demirkol M, Doğan MB, Binguler AHE, Karaarslan N, Balak N. Morphological changes after open lumbar microdiscectomy at 2-year follow-up. J Back Musculoskelet Rehabil 2024; 37:75-87. [PMID: 37599519 DOI: 10.3233/bmr-220371] [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] [Indexed: 08/22/2023]
Abstract
BACKGROUND It is known that a possible decrease in disc height (DH) and foraminal size after open lumbar microdiscectomy (OLM) may cause pain in the long term. However, there is still insufficient information about the short- or long-term pathoanatomical and morphological effects of microdiscectomy. For example, the exact temporal course of the change in DH is not well known. OBJECTIVE The purpose of this study was to examine morphological changes in DH and foramen dimensions after OLM. METHODS In patients who underwent OLM for single-level lumbar disc herniation, MRI scans were obtained before surgery, and at an average of two years after surgery. In addition to DH measurements, foraminal area (FA), foraminal height (FH), superior foraminal width (SFW), and inferior foraminal width (IFW), were measured bilaterally. RESULTS A postoperative increase in DH was observed at all vertebral levels, with an average of 5.5%. The mean right FHs were 15.3 mm and 15.7 mm before and after surgery, respectively (p= 0.062), while the left FHs were 14.8 mm and 15.8 mm before and after surgery (p= 0.271). The mean right SFW was 5.4 mm before surgery and 5.7 mm after surgery, while the mean right IFW ranged from 3.6 mm to 3.9 mm. The mean left SFW was 4.8 mm before surgery and 5.2 mm after surgery, while the mean left IFW ranged from 3.5 mm to 3.9 mm. Before surgery, the FAs were, on average, 77.1 mm2 and 75.6 mm2 on the right and left sides, respectively. At the 2-year follow-up, the mean FAs were 84.0 mm2 and 80.2 mm2 on the right and left sides, respectively. CONCLUSIONS Contrary to prevalent belief, in patients who underwent single-level unilateral OLM, we observed that there may be an increase rather than a decrease in DH or foramen size at the 2-year follow-up. Our findings need to be confirmed by studies with larger sample sizes and longer follow-ups.
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Affiliation(s)
- Abdullah Talha Şimşek
- Department of Neurosurgery, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Begümhan Baysal
- Department of Radiology, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Baha Eldin Adam
- Department of Neurosurgery, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Fatih Çalış
- Department of Neurosurgery, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Arda Topçam
- Department of Neurosurgery, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Mahmut Demirkol
- Department of Neurosurgery, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Mahmut Bilal Doğan
- Department of Radiology, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ayse Hande Erol Binguler
- Department of Industrial Engineering, Faculty of Engineering, Marmara University, Istanbul, Turkey
| | - Numan Karaarslan
- Department of Neurosurgery, Istanbul Haliç University, Istanbul, Turkey
| | - Naci Balak
- Department of Neurosurgery, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
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Balak N, Tsianaka E, Zoia C, Sekhar A, Ganau M. Editorial: From simulation to the operating theatre: new insights in translational surgery. Front Med Technol 2023; 5:1282248. [PMID: 37810948 PMCID: PMC10552562 DOI: 10.3389/fmedt.2023.1282248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/14/2023] [Indexed: 10/10/2023] Open
Affiliation(s)
- Naci Balak
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Hospital, Istanbul, Türkiye
| | - Eleni Tsianaka
- Neurosurgery Department, Kuwait Hospital, Sabah Al Salem, Kuwait
| | - Cesare Zoia
- Neurosurgery Unit, Ospedale Moriggia Pelascini, Gravedona, Italy
| | - Amitendu Sekhar
- Department of Neurosurgery, Bahrain Defence Force Royal Medical Services Military Hospital, West Riffa, Bahrain
| | - Mario Ganau
- Nuffield Department of Neurosciences, University of Oxford, Oxford, United Kingdom
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Balak N. Letter to the Editor. Identifying the brand and model of implanted shunts for revision planning in hydrocephalus. J Neurosurg 2023; 139:1492-1493. [PMID: 37486874 DOI: 10.3171/2023.4.jns23904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
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Baran O, Saygi T, Balak N. Optimal anatomical angle and distance for drilling in cervical oblique corpectomy: A surgical anatomical study. J Craniovertebr Junction Spine 2023; 14:137-143. [PMID: 37448508 PMCID: PMC10336893 DOI: 10.4103/jcvjs.jcvjs_26_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: 03/04/2023] [Accepted: 04/12/2023] [Indexed: 07/15/2023] Open
Abstract
Background One of the difficulties of oblique corpectomy, less discussed in the literature, is the problem of how to achieve an optimum corpectomy. Therefore, this anatomico-radiological study was conducted to shed light on the use of the microscope at an appropriate angle and optimum drill distances in clinical cases undergoing cervical oblique corpectomy surgery. Materials and Methods We examined the average distance of the diagonal line extending from the medial aspect of the ipsilateral vertebral foramen to the contralateral pedicle in cervical computed tomography -angiography axial scans in four cervical vertebrae, C3, C4, C5, and C6. We also measured the average angle between this diagonal trajectory and the horizontal line, making a total of 712 measurements in 89 patients. Results We found that horizontal drilling with an average length of 23-26 mm at an acute angle of about 22° -23° is optimal for adequate decompression of the spinal cord in the oblique corpectomy approach. Depending on the patient and the level of the vertebra, the distance and the angle of the horizontal drilling may range from 18 mm to 31 mm and from 15° to 33°, respectively. Conclusions For an optimum cervical oblique corpectomy that provides adequate spinal cord decompression and maintains spinal stability, it is necessary to operate under a surgical microscope positioned at an acute angle and to know the horizontal drilling distance.
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Affiliation(s)
- Oguz Baran
- Department of Neurosurgery, Koç University Hospital, Istanbul, Turkey
| | - Tahsin Saygi
- Department of Neurosurgery, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Naci Balak
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Hospital, Istanbul, Turkey
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Akdemir H, Calis F, Simsek AT, Balak N. Letter: Difficulty in Tracing Manufacturer and Brand Names on Ventriculoperitoneal Shunt Catheters and Valves. Neurosurgery 2023; 92:e25-e26. [PMID: 36637280 DOI: 10.1227/neu.0000000000002238] [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] [Received: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 01/14/2023] Open
Affiliation(s)
- Huseyin Akdemir
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Turkey
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Balak N. Choice of surgical procedure in the treatment of brain abscess. Br J Neurosurg 2023; 37:121. [PMID: 34821178 DOI: 10.1080/02688697.2021.2007216] [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: 10/19/2022]
Affiliation(s)
- Naci Balak
- MD, IFAANS, Department of Neurosurgery, Göztepe Education and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
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Akdemir H, Aktas B, Simsek AT, Calis F, Balak N. Proposal for a spiral tube piece in the design of ventriculoperitoneal shunts. Childs Nerv Syst 2023; 39:9-11. [PMID: 36307606 DOI: 10.1007/s00381-022-05727-w] [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] [Received: 08/27/2022] [Accepted: 10/25/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Huseyin Akdemir
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Prof. Dr. SüleymanYalçın City Hospital, Istanbul, Turkey
| | - Büsra Aktas
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Prof. Dr. SüleymanYalçın City Hospital, Istanbul, Turkey
| | - A Talha Simsek
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Prof. Dr. SüleymanYalçın City Hospital, Istanbul, Turkey
| | - Fatih Calis
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Prof. Dr. SüleymanYalçın City Hospital, Istanbul, Turkey
| | - Naci Balak
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Prof. Dr. SüleymanYalçın City Hospital, Istanbul, Turkey.
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Simsek AT, Calis F, Ersoy Dursun F, Cobanoglu Simsek B, Akdemir H, Alyanak D, Arveladze N, Topyalin N, Cine HS, Adam BE, Balak N. Giant cranial plasmacytoma: case report and discussion of a potential relationship with sex hormones. Neurol Neurochir Pol 2022; 57:314-316. [PMID: 36533864 DOI: 10.5603/pjnns.a2022.0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Abdullah Talha Simsek
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Turkey
| | - Fatih Calis
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Turkey
| | - Fadime Ersoy Dursun
- Department of Haematology, Istanbul Medeniyet University, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Türkiye
| | - Bengu Cobanoglu Simsek
- Department of Pathology, Istanbul Medeniyet University, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Türkiye
| | - Huseyin Akdemir
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Turkey
| | - Deniz Alyanak
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Turkey
| | - Natia Arveladze
- Department of Anaesthesiology, Istanbul Medeniyet University, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Türkiye
| | - Nur Topyalin
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Turkey
| | - Hidayet Safak Cine
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Turkey
| | - Baha Eldin Adam
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Turkey
| | - Naci Balak
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Turkey.
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Balak N, Shrestha P, Agboola K. The crucial role of ethical hospital administration in neurosurgery education. Front Health Serv 2022; 2:860266. [PMID: 36925839 PMCID: PMC10012789 DOI: 10.3389/frhs.2022.860266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 07/06/2022] [Indexed: 06/18/2023]
Affiliation(s)
- Naci Balak
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Hospital, Istanbul, Turkey
| | | | - Kayode Agboola
- Department of Neurosurgery, Institute of Neurosurgery, A.P. Romodanov, National Academy of Medical Sciences (NAMS) of Ukraine, Kiev, Ukraine
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Mathiesen TI, Balak N, Samprón N, Broekman M, Bolger C. Ethico-legal regional differences in European neurosurgical practice: Part 1-pre-COVID-19 era. Brain Spine 2022; 2:100899. [PMID: 36248159 PMCID: PMC9562226 DOI: 10.1016/j.bas.2022.100899] [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] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/30/2022] [Accepted: 06/02/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Professionalism entails expert knowledge, self-regulation, accountability, and professional ethics. These factors are influenced by culture, political observance, professional maturity, education, and occupation; ethical practices may thus vary between countries and affect how neurosurgery is practiced. RESEARCH QUESTION This paper aims to conduct a survey that addresses whether ethico-legal practices differ in European countries and whether existing ethical guidelines have been implemented. MATERIAL AND METHODS A questionnaire survey was used to examine the ethico-legal situation in 29 European countries or regions. The reports were validated by representatives of each nation. RESULTS Existing guidelines had been implemented to a minimal extent. Major regional and national differences were found in attitudes toward life and death, prioritization, and issues related to professional conduct. DISCUSSION AND CONCLUSION The results of this survey reveal inadequacies and weaknesses of policies and resources, which should spark national discussions to improve the conditions that influence professional ethics. Unfortunately, only a minority of neurosurgeons know the neurosurgical ethics guidelines and apply them in their decision making. Our findings highlight the importance of values and professional ethics in decision making.
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Affiliation(s)
- Tiit I. Mathiesen
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Ethico-Legal Committee of the European Association of Neurosurgical Societies (EANS), Brussels, Belgium
| | - Naci Balak
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Hospital, Istanbul, Turkey
- Ethico-Legal Committee of the European Association of Neurosurgical Societies (EANS), Brussels, Belgium
| | - Nicolás Samprón
- Servicio de Neurocirugía, Hospital Universitario Donostia, San Sebastián, Spain
- Ethico-Legal Committee of the European Association of Neurosurgical Societies (EANS), Brussels, Belgium
| | - Marike Broekman
- Departments of Neurosurgery, Haaglanden Medical Center and Leiden University Medical Center, The Hague, the Netherlands
- Ethico-Legal Committee of the European Association of Neurosurgical Societies (EANS), Brussels, Belgium
| | - Ciarán Bolger
- Department of Clinical Neuroscience, Beaumont Hospital, Dublin, Ireland
- Ethico-Legal Committee of the European Association of Neurosurgical Societies (EANS), Brussels, Belgium
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Balak N. Letter: Anterior Nucleus of the Thalamus Deep Brain Stimulation With Concomitant Vagus Nerve Stimulation for Drug-Resistant Epilepsy. Neurosurgery 2022; 90:e101-e102. [PMID: 35045062 DOI: 10.1227/neu.0000000000001828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/10/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Naci Balak
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Hospital, Istanbul, Turkey
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Balak N, Inan D, Ganau M, Zoia C, Sönmez S, Kurt B, Akgül A, Tez M. A simple mathematical tool to forecast COVID-19 cumulative case numbers. Clin Epidemiol Glob Health 2021; 12:100853. [PMID: 34395949 PMCID: PMC8352661 DOI: 10.1016/j.cegh.2021.100853] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 05/31/2021] [Revised: 07/20/2021] [Accepted: 08/04/2021] [Indexed: 02/07/2023] Open
Abstract
Objective Mathematical models are known to help determine potential intervention strategies by providing an approximate idea of the transmission dynamics of infectious diseases. To develop proper responses, not only are more accurate disease spread models needed, but also those that are easy to use. Materials and methods As of July 1, 2020, we selected the 20 countries with the highest numbers of COVID-19 cases in the world. Using the Verhulst–Pearl logistic function formula, we calculated estimates for the total number of cases for each country. We compared these estimates to the actual figures given by the WHO on the same dates. Finally, the formula was tested for longer-term reliability at t = 18 and t = 40 weeks. Results The Verhulst–Pearl logistic function formula estimated the actual numbers precisely, with only a 0.5% discrepancy on average for the first month. For all countries in the study and the world at large, the estimates for the 40th week were usually overestimated, although the estimates for some countries were still relatively close to the actual numbers in the forecasting long term. The estimated number for the world in general was about 8 times that actually observed for the long term. Conclusions The Verhulst–Pearl equation has the advantage of being very straightforward and applicable in clinical use for predicting the demand on hospitals in the short term of 4–6 weeks, which is usually enough time to reschedule elective procedures and free beds for new waves of the pandemic patients.
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Affiliation(s)
- Naci Balak
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Education and Research Hospital, Istanbul, Turkey
- School of Applied Sciences, Marmara University, Istanbul, Turkey
| | - Deniz Inan
- Department of Statistics, Faculty of Arts and Sciences, Marmara University, Istanbul, Turkey
| | - Mario Ganau
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Cesare Zoia
- Department of Neurosurgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sinan Sönmez
- School of Applied Sciences, Marmara University, Istanbul, Turkey
| | - Batuhan Kurt
- School of Applied Sciences, Marmara University, Istanbul, Turkey
| | - Ahmet Akgül
- School of Applied Sciences, Marmara University, Istanbul, Turkey
| | - Müjgan Tez
- Department of Statistics, Faculty of Arts and Sciences, Marmara University, Istanbul, Turkey
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Balak N. Letter: Length of Stay Beyond Medical Readiness in a Neurosurgical Patient Population and Associated Healthcare Costs. Neurosurgery 2021; 89:E168-E169. [PMID: 34089328 DOI: 10.1093/neuros/nyab198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 04/29/2021] [Indexed: 02/03/2023] Open
Affiliation(s)
- Naci Balak
- Department of Neurosurgery Göztepe Education and Research Hospital Istanbul Medeniyet University Istanbul, Turkey
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Efendioğlu M, Şanli E, Türkoğlu C, Balak N. Reduced Serum sRANKL and sTREM2 Levels in High-Grade Gliomas: Association with Prognosis. Noro Psikiyatr Ars 2021; 58:133-136. [PMID: 34188596 PMCID: PMC8214753 DOI: 10.29399/npa.27536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/23/2020] [Accepted: 12/07/2020] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION High-grade gliomas (HGG), including Glioblastoma multiforme (GBM), account for the majority of primary brain tumors. Nevertheless, prognostic and diagnostic biomarkers are quite limited for HGG. The objective of this study was to investigate the prognostic value of sRANKL and sTREM2 levels in HGG patients. METHODS Twelve consecutive patients with HGG, 14 patients with non-glial tumors (non-GT) and 20 age and gender-matched healthy controls were recruited. Overall survival duration of the patients was recorded. Pre-operative serum levels of sRANKL and sTREM2 were measured by ELISA. Tumors of HGG patients were analyzed by immunohistochemical staining for p53 and Ki67 and percentage scores were calculated. RESULTS Patients with HGG and non-GT showed lower serum sRANKL and sTREM2 levels than healthy individuals. Levels of sRANKL were inversely correlated with the overall survival of patients (p=0.002, R=0.787), while sTREM2 levels were inversely correlated with p53 score (p=0.018, R=-0.666) but not survival. CONCLUSION Brain tumor patients show suppressed levels of glial activity biomarkers in the peripheral circulation. Serum sRANKL levels may serve as a potential prognostic biomarker for HGG.
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Affiliation(s)
- Mustafa Efendioğlu
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Elif Şanli
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | | | - Naci Balak
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Education and Research Hospital, Istanbul, Turkey
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Balak N. Letter to the Editor. Hidden traces of the exemplary mentorship of Harvey Cushing in Europe. J Neurosurg 2021; 135:1284. [PMID: 34049273 DOI: 10.3171/2021.3.jns21529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Affiliation(s)
- Naci Balak
- Department of NeurosurgeryIstanbul Medeniyet UniversityGöztepe HospitalIstanbul, Turkey
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Affiliation(s)
- Naci Balak
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Education and Research Hospital, Kadiköy, Istanbul, Turkey.
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Balak N. Letter: Deep Brain Stimulation in Epilepsy: A Role for Modulation of the Mammillothalamic Tract in Seizure Control? Neurosurgery 2021; 88:E283-E284. [PMID: 33428768 DOI: 10.1093/neuros/nyaa500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/20/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Naci Balak
- Department of Neurosurgery Göztepe Education and Research Hospital Istanbul Medeniyet University Istanbul, Turkey
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Balak N. Lumbar Microdiskectomy. J Neurol Surg A Cent Eur Neurosurg 2021; 82:294-296. [PMID: 33618412 DOI: 10.1055/s-0040-1722749] [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: 10/22/2022]
Affiliation(s)
- Naci Balak
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Hospital, Istanbul, Turkey
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Affiliation(s)
- N Balak
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Hospital, Istanbul, Turkey.
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Eijkholt M, Broekman M, Balak N, Mathiesen T. Three pitfalls of accountable healthcare rationing. J Med Ethics 2021; 47:medethics-2020-106943. [PMID: 33441304 DOI: 10.1136/medethics-2020-106943] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/24/2020] [Accepted: 12/07/2020] [Indexed: 06/12/2023]
Abstract
A pandemic may cause a sudden imbalance between available medical resources and medical needs where fundamental care to a patient cannot be delivered. Inability to fulfil a professional commitment to deliver care as needed can lead to distress among caregivers and patients. This distress is sometimes alleviated through mechanisms that hide the facts that care is rationed and not all medical needs are met. We have identified three mechanisms that jeopardise accountable and optimal allocation of resources: (1) hidden value judgements that allow rationing under the disguise of triage or prioritisation, (2) disguised conflict of interest between societal and individual patient's needs and (3) concealed biases in the application of medical tools. Under these three pitfalls decisions of resource allocation and who gets treated are handled as medical decisions: normative decisions are concealed and perceived as falling with the realm of medical judgement. Value judgements and moral agency are hidden to offer a 'false sense of medical judgement', while in fact there are several ethical judgements and biases at stake. The three pitfalls entail hidden normative deliberation and are inappropriate for sustainable healthcare delivery and resource allocation. We believe it is necessary to maintain transparency in decision making under conditions of insufficient resources to maintain trust in professional care givers and secure fair treatment allocation. Recognition of the pitfalls, by applying our recommendations, may help to ensure transparent and accountable distribution of care and contribute to public acceptance of the ethics behind rationing.
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Affiliation(s)
- Marleen Eijkholt
- Unit Ethics and Health Care, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Marike Broekman
- Department of neurosurgery, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Naci Balak
- Istanbul Medeniyet University, Istanbul, İstanbul, Turkey
| | - Tiit Mathiesen
- Department of Neurosurgery and Dept of Clinical Medicine, University of Copenhagen, Copenhagen University Hospital, Kobenhavn, Denmark
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Stockholm, Sweden
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Affiliation(s)
- Naci Balak
- Dept of Neurosurgery, Istanbul Medeniyet University, Göztepe Education and Research Hospital, Istanbul, Turkey.
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Baran O, Balak N, Baydin S, Aydin I, Kayhan A, Evran S, Kemerdere R, Tanriover N. Assessing the connectional anatomy of superior and lateral surgical approaches for medial temporal lobe epilepsy. J Clin Neurosci 2020; 81:378-389. [PMID: 33222947 DOI: 10.1016/j.jocn.2020.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/03/2020] [Revised: 09/15/2020] [Accepted: 10/03/2020] [Indexed: 12/13/2022]
Abstract
The most common approaches in the treatment of epilepsy, the trans-sylvian selective amygdalohippocampectomy (SAH) and the anterior temporal lobe resection (ATLR) reach the medial temporal lobe through different surgical routes. Our aim was to delineate the white matter (WM) fiber tracts at risk in relation to trans-sylvian SAH and ATLR by defining each fascicle en route to medial temporal lobe during each approach. ATLR and trans-sylvian SAH were performedand related WM tracts en route to medial temporal region were presented in relation to the relevant approaches and surrounding neurovascular structures. The WM tracts most likely to be disrupted during trans-sylvian SAH along the roof of the temporal horn were the UF - and less commonly IFOF - at the layer of the external capsule, anterior commissure, anterior bend of optic radiations, and sublenticular internal capsule. Amygdaloid projections to the claustrum, putamen and globus pallidus, the tail of caudate and the peduncle of the lentiform nucleus were also in close proximity to the resection cavity. Fiber tracts most likely to be impaired during ATLR included the UF, ILF, IFOF, anterior commissure, optic radiations, and, less likely, the vertical ventral segment of the arcuate fascicle. Both ATLR and trans-sylvian SAH carry the risk of injury to WM pathways, which may result in unpredictable functional loss. A detailed 3-D knowledge of the related connectional anatomy will help subside neurocognitive, neuroophtalmologic, neurolinguistic complications of epilepsy surgery, providing an opportunity to tailor the surgery according to patient's unique connectional and functional anatomy.
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Affiliation(s)
- Oguz Baran
- Department of Neurosurgery, Koç University Hospital, Istanbul, Turkey; Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Istanbul, Turkey
| | - Naci Balak
- Istanbul Medeniyet University, Goztepe Education and Research Hospital, Istanbul, Turkey
| | - Serhat Baydin
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Istanbul, Turkey; Ondokuz Mayis University, Medical Faculty, Department of Neurosurgery, Samsun, Turkey
| | - Ilhan Aydin
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Istanbul, Turkey; Medical Park Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Ahmet Kayhan
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Istanbul, Turkey; Haseki Research and Training Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Sevket Evran
- Haseki Research and Training Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Rahsan Kemerdere
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurosurgery, Istanbul, Turkey
| | - Necmettin Tanriover
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Istanbul, Turkey; Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurosurgery, Istanbul, Turkey.
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Balak N. Carotid Endarterectomy in Asymptomatic Patients with Carotid Artery Stenosis. Ann Vasc Surg 2020; 71:e1-e2. [PMID: 33157246 DOI: 10.1016/j.avsg.2020.09.049] [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] [Received: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Naci Balak
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Education and Research Hospital, Istanbul, Turkey.
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Balak N. Letter to the Editor. Understanding the anatomy of the dura mater. J Neurosurg Spine 2020:1-2. [PMID: 33126218 DOI: 10.3171/2020.8.spine201586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Mathiesen T, Arraez M, Asser T, Balak N, Barazi S, Bernucci C, Bolger C, Broekman MLD, Demetriades AK, Feldman Z, Fontanella MM, Foroglou N, Lafuente J, Maier AD, Meyer B, Niemelä M, Roche PH, Sala F, Samprón N, Sandvik U, Schaller K, Thome C, Thys M, Tisell M, Vajkoczy P, Visocchi M. A snapshot of European neurosurgery December 2019 vs. March 2020: just before and during the Covid-19 pandemic. Acta Neurochir (Wien) 2020; 162:2221-2233. [PMID: 32642834 PMCID: PMC7343382 DOI: 10.1007/s00701-020-04482-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [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] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/30/2020] [Indexed: 11/30/2022]
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or Covid-19), which began as an epidemic in China and spread globally as a pandemic, has necessitated resource management to meet emergency needs of Covid-19 patients and other emergent cases. We have conducted a survey to analyze caseload and measures to adapt indications for a perception of crisis. Methods We constructed a questionnaire to survey a snapshot of neurosurgical activity, resources, and indications during 1 week with usual activity in December 2019 and 1 week during SARS-CoV-2 pandemic in March 2020. The questionnaire was sent to 34 neurosurgical departments in Europe; 25 departments returned responses within 5 days. Results We found unexpectedly large differences in resources and indications already before the pandemic. Differences were also large in how much practice and resources changed during the pandemic. Neurosurgical beds and neuro-intensive care beds were significantly decreased from December 2019 to March 2020. The utilization of resources decreased via less demand for care of brain injuries and subarachnoid hemorrhage, postponing surgery and changed surgical indications as a method of rationing resources. Twenty departments (80%) reduced activity extensively, and the same proportion stated that they were no longer able to provide care according to legitimate medical needs. Conclusion Neurosurgical centers responded swiftly and effectively to a sudden decrease of neurosurgical capacity due to relocation of resources to pandemic care. The pandemic led to rationing of neurosurgical care in 80% of responding centers. We saw a relation between resources before the pandemic and ability to uphold neurosurgical services. The observation of extensive differences of available beds provided an opportunity to show how resources that had been restricted already under normal conditions translated to rationing of care that may not be acceptable to the public of seemingly affluent European countries. Electronic supplementary material The online version of this article (10.1007/s00701-020-04482-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- T Mathiesen
- Department of Neurosurgery, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - M Arraez
- Department of Neurosurgery, Carlos Haya University Hospital,, University of Malaga, Malaga, Spain
| | - T Asser
- University of Tartu, Tartu, Estonia
| | - N Balak
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Education and Research Hospital, Istanbul, Turkey
| | - S Barazi
- King's College Hospital, London, UK
| | - C Bernucci
- Department of Neuroscience and Surgery of the Nervous System, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - C Bolger
- National Centre for Neurosurgery, Beaumont Hospital, Dublin, Ireland
| | - M L D Broekman
- Departments of Neurosurgery, Haaglanden Medical Center and Leiden University Medical Center, Leiden University, Leiden, Zuid-Holland, the Netherlands
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - A K Demetriades
- Department of Neurosurgery, Western General Hospital, Edinburgh, UK
| | - Z Feldman
- Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel
| | - M M Fontanella
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Spedali Civili di Brescia, Brescia, Italy
| | - N Foroglou
- Department of Neurosurgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - J Lafuente
- Neurosurgery, Hospital Del Mar, Barcelona, Spain
| | - A D Maier
- Department of Neurosurgery, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - B Meyer
- Department of Neurosurgery, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - M Niemelä
- Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - P H Roche
- Department of Neurosurgery, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - F Sala
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University Hospital, Verona, Italy
| | - N Samprón
- Servicio de Neurocirugía, Hospital Universitario Donostia, San Sebastián, Spain
| | - U Sandvik
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurosurgery, Karolinska University Hospital, Solna, Sweden
| | - K Schaller
- Department of Neurosurgery, Geneva University Medical Center & Faculty of Medicine, Geneva, Switzerland
| | - C Thome
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - M Thys
- Neurosciences Department, Grand Hopital de Charleroi, Charleroi, Belgium
| | - M Tisell
- Department of Neurosurgery, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - P Vajkoczy
- Department of Neurosurgery, Charite Universitätsmedizin Berlin, Berlin, Germany
| | - M Visocchi
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
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Ganau M, Netuka D, Broekman M, Zoia C, Tsianaka E, Schwake M, Balak N, Sekhar A, Ridwan S, Clusmann H. Neurosurgeons and the fight with COVID-19: a position statement from the EANS Individual Membership Committee. Acta Neurochir (Wien) 2020; 162:1777-1782. [PMID: 32472377 PMCID: PMC7258601 DOI: 10.1007/s00701-020-04360-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/18/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Mario Ganau
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - David Netuka
- Department of Neurosurgery and Neuro-oncology, 1st Medical Faculty, Charles University, Central Military Hospital, Prague, Czech Republic
| | - Marike Broekman
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, & Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Massachusetts General Hospital, Boston, MA USA
| | - Cesare Zoia
- Department of Neurosurgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Eleni Tsianaka
- Department of Neurosurgery, Dar Al Shifa Hospital, Kuwait City, Kuwait
| | - Michael Schwake
- Department of Neurosurgery, University Hospital Muenster, Muenster, Germany
| | - Naci Balak
- Department of Neurosurgery, Istanbul Medeniyet University Göztepe Education and Research Hospital, Istanbul, Turkey
| | - Amitendu Sekhar
- Department of Neurosurgery, Paras Hospital, Udaipur, Rajasthan India
| | - Sami Ridwan
- Department of Neurosurgery, Paracelsus-Klinik, Osnabrück, Germany
| | - Hans Clusmann
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
| | - EANS IM Committee
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Department of Neurosurgery and Neuro-oncology, 1st Medical Faculty, Charles University, Central Military Hospital, Prague, Czech Republic
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, & Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Massachusetts General Hospital, Boston, MA USA
- Department of Neurosurgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Neurosurgery, Dar Al Shifa Hospital, Kuwait City, Kuwait
- Department of Neurosurgery, University Hospital Muenster, Muenster, Germany
- Department of Neurosurgery, Istanbul Medeniyet University Göztepe Education and Research Hospital, Istanbul, Turkey
- Department of Neurosurgery, Paras Hospital, Udaipur, Rajasthan India
- Department of Neurosurgery, Paracelsus-Klinik, Osnabrück, Germany
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
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Hulsbergen AFC, Eijkholt MM, Balak N, Brennum J, Bolger C, Bohrer AM, Feldman Z, Holsgrove D, Kitchen N, Mathiesen TI, Moojen WA, Samprón N, Sames M, Sandvik U, Tisell M, Broekman MLD. Ethical triage during the COVID-19 pandemic: a toolkit for neurosurgical resource allocation. Acta Neurochir (Wien) 2020; 162:1485-1490. [PMID: 32405671 PMCID: PMC7220806 DOI: 10.1007/s00701-020-04375-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/25/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND The COVID-19 pandemic confronts healthcare workers, including neurosurgeons, with difficult choices regarding which patients to treat. METHODS In order to assist ethical triage, this article gives an overview of the main considerations and ethical principles relevant when allocating resources in times of scarcity. RESULTS We discuss a framework employing four principles: prioritizing the worst off, maximizing benefits, treating patients equally, and promoting instrumental value. We furthermore discuss the role of age and comorbidity in triage and highlight some principles that may seem intuitive but should not form a basis for triage. CONCLUSIONS This overview is presented on behalf of the European Association of Neurosurgical Societies and can be used as a toolkit for neurosurgeons faced with ethical dilemmas when triaging patients in times of scarcity.
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Affiliation(s)
- Alexander F C Hulsbergen
- Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium.
- Departments of Neurosurgery, Haaglanden Medical Center and Leiden University Medical Center, Lijnbaan 32, 2512, VA, The Hague, The Netherlands.
| | - Marleen M Eijkholt
- Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium
- Unit Ethics and Health Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Naci Balak
- Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium
| | - Jannick Brennum
- Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium
| | - Ciarán Bolger
- Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium
- Department of Clinical Neuroscience, Beaumont Hospital, Dublin, Ireland
| | - Anna-Margarete Bohrer
- Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium
| | - Zeev Feldman
- Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium
| | - Daniel Holsgrove
- Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium
| | - Neil Kitchen
- Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium
| | - Tiit I Mathiesen
- Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium
- Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Intitutet, Stockholm, Sweden
| | - Wouter A Moojen
- Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium
- Departments of Neurosurgery, Haaglanden Medical Center and Leiden University Medical Center, Lijnbaan 32, 2512, VA, The Hague, The Netherlands
| | - Nicolás Samprón
- Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium
- Department of Neurosurgery, Hospital Universitario Donostia, San Sebastián, Spain
| | - Martin Sames
- Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium
| | - Ulrika Sandvik
- Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium
- Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Intitutet, Stockholm, Sweden
| | - Magnus Tisell
- Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium
| | - Marike L D Broekman
- Ethics Committee of the European Association of Neurosurgical Societies, Brussels, Belgium.
- Departments of Neurosurgery, Haaglanden Medical Center and Leiden University Medical Center, Lijnbaan 32, 2512, VA, The Hague, The Netherlands.
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Balak N, Broekman MLD, Mathiesen T. Ethics in contemporary health care management and medical education. J Eval Clin Pract 2020; 26:699-706. [PMID: 31975509 DOI: 10.1111/jep.13352] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 07/11/2019] [Revised: 11/15/2019] [Accepted: 12/27/2019] [Indexed: 01/20/2023]
Abstract
RATIONALE The health care landscape is changing: it has become the largest part of the economy and changes in public management systems will greatly affect how we practice medicine in the future. Medical education will be more important than ever to ensure patients get the best care with empathy. However, new public management systems implemented without thorough analysis might challenge medical education. An increasing number of public health care institutions provide services based on competitive market rules and express their goals in financial terms and have set financial gains as their main goal, which contradicts the fundamental nature of medical ethics and practice. AIMS AND OBJECTIVES To explore new public management to identify potential problems and offer possible solutions for medical education and health care institutions. METHODS A scoping review of the literature on public administration, hospital management, professionalism, ethics, and medical education was undertaken to map evidence on the topic and identify main concepts and knowledge gaps in the influence of management systems on the quality of medical educational practices. RESULTS If the accelerating changes in public management are cursorily analysed, medical education may lose the esteem in which it has long been held globally. Without precautions, the so-called new public management medical faculties will-at best-generate economic benefit, following a business model with strict quality rules, regulations, standardized products, and complex analysis and measurement systems. However, these faculties will function at a level far below the ideal of teaching institutions distinguished for their outstanding components, creativity, and ambience. CONCLUSIONS Patients and teaching values are not reducible to financial terms only and the acknowledgement of non-financial values is fundamental to achieve quality in health care and education. The most essential step could be selecting managers who will implement public management principles while taking into account both business requirements and medical ethics.
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Affiliation(s)
- Naci Balak
- Department of Neurosurgery, Göztepe Education and Research Hospital, Medeniyet University, Istanbul, Turkey
| | - Marike L D Broekman
- Cushing Neurosurgical Outcomes Centre, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands.,Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Tiit Mathiesen
- Department of Neurosurgery, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark, and Karolinska Institutet, Stockholm, Sweden
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Affiliation(s)
- Emine Seyma Denli Yalvac
- Department of Cardiovascular Surgery, Göztepe Education and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Naci Balak
- Department of Neurosurgery, Göztepe Education and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
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Baran O, Baydin S, Gungor A, Balak N, Middlebrooks E, Saygi T, Aydin I, Tanriover N. Surgical Approaches to the Thalamus in Relation to the White Matter Tracts of the Cerebrum. World Neurosurg 2019; 128:e1048-e1086. [DOI: 10.1016/j.wneu.2019.05.068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 05/08/2019] [Indexed: 12/20/2022]
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Balak N, Baran O, Denli Yalvac ES, Esen Aydin A, Tanriover N. Surgical technique for the protection of the cervical sympathetic trunk in anterolateral oblique corpectomy: A new cadaveric demonstration. J Clin Neurosci 2019; 63:267-271. [DOI: 10.1016/j.jocn.2019.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/15/2018] [Accepted: 01/18/2019] [Indexed: 10/27/2022]
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Denli Yalvac ES, Cumbul A, Uslu U, Soztutar E, Bilisli E, Balak N. A New Perspective in Comparing Injuries Caused by Short-Duration External and Internal Forces in Saphenous Vein. Heart Surg Forum 2019; 22:E063-E069. [PMID: 31013213 DOI: 10.1532/hsf.2303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 01/16/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Great saphenous vein (GSV) graft failure is one of the major reasons for repeat bypass grafting. A comparison of the effects of simultaneous, short-duration, externally squeezing and internally distending forces on the same segment of ex-vivo human GSV has not yet been published, although similar studies have compared the experimental injury of different ex-vivo human veins. METHODS Approximately 8-cm-long segments of GSV were harvested from each of the 15 patients. For each specimen, one end of the vein piece was occluded at a distance of 1 cm with an external cross-clamp for 5 min and the other end was similarly occluded at a distance of 1 cm by an endoluminal balloon. The middle sections of the veins, which were not occluded by any means, were taken as the control group. Two histologists, who were blinded to the groups, graded the hematoxylin and eosin (H&E) and Weigert-Van Gieson (WVG) stained sections semi-quantitatively and performed the histomorphometric measurements. RESULTS The result of the histopathological evaluation of the intima layer showed that the microscopic scoring of lesions in the balloon group was significantly higher than that in the clamp and control groups (5.16 ± 1.32, 3.83 ± 0.75, and 1.00 ± 1.09, respectively; P < .001). In the adventitia layer, this level of scoring increased more in the clamp group than in the balloon and control groups (5.16 ± 1.16, 3.00 ± 0.89, and 0.16 ± 0.40, respectively, P < .001). CONCLUSION Both the endoluminal balloon and external clamp techniques have harmful effects on the vein wall. Studying different kind of forces on different veins cannot provide us with reliable comparisons.
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Affiliation(s)
- Emine Seyma Denli Yalvac
- Department of Cardiovascular Surgery, Göztepe Education and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Alev Cumbul
- Department of Histology and Embryology, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
| | - Unal Uslu
- Department of Histology and Embryology, Göztepe Education and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Erdem Soztutar
- Department of Anatomy, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
| | - Edibe Bilisli
- Department of Anatomy, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
| | - Naci Balak
- Department of Neurosurgery, Göztepe Education and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
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Balak N. In Reply to “Joy of Learning: Mammilotegmental Tract Connecting 2 Circuits of Memory and Pleasure in Brain”. World Neurosurg 2018; 118:389-390. [DOI: 10.1016/j.wneu.2018.07.025] [Citation(s) in RCA: 3] [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: 07/01/2018] [Accepted: 07/03/2018] [Indexed: 12/18/2022]
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Castlen JP, Cote DJ, Moojen WA, Robe PA, Balak N, Brennum J, Ammirati M, Mathiesen T, Broekman ML. The Changing Health Care Landscape and Implications of Organizational Ethics on Modern Medical Practice. World Neurosurg 2017; 102:420-424. [DOI: 10.1016/j.wneu.2017.03.073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 03/16/2017] [Indexed: 10/19/2022]
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Cote DJ, Balak N, Brennum J, Holsgrove DT, Kitchen N, Kolenda H, Moojen WA, Schaller K, Robe PA, Mathiesen T, Broekman ML. Ethical difficulties in the innovative surgical treatment of patients with recurrent glioblastoma multiforme. J Neurosurg 2017; 126:2045-2050. [PMID: 28430037 DOI: 10.3171/2016.11.jns162488] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- David J Cote
- Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Naci Balak
- Department of Neurosurgery, Göztepe Education and Research Hospital, Istanbul, Turkey
| | - Jannick Brennum
- Department of Neurosurgery, Rigshopsitalet, University of Copenhagen, Denmark
| | - Daniel T Holsgrove
- Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom
| | - Neil Kitchen
- The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Herbert Kolenda
- Department of Neurosurgery, Agaplesion Diakonieklinikum, Rotenburg, Germany
| | - Wouter A Moojen
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands.,Department of Neurosurgery, Medical Center Haaglanden, The Hague, The Netherlands
| | | | - Pierre A Robe
- Department of Neurosurgery, University Medical Center, Utrecht, The Netherlands
| | - Tiit Mathiesen
- Department of Neurosurgery, Karolinska Institute, Stockholm, Sweden ; and
| | - Marike L Broekman
- Department of Neurosurgery, University Medical Center, Utrecht, The Netherlands.,Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
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Cote DJ, Bredenoord AL, Smith TR, Ammirati M, Brennum J, Mendez I, Ammar AS, Balak N, Bolles G, Esene IN, Mathiesen T, Broekman ML. Ethical clinical translation of stem cell interventions for neurologic disease. Neurology 2016; 88:322-328. [PMID: 27927932 DOI: 10.1212/wnl.0000000000003506] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/11/2016] [Indexed: 12/18/2022] Open
Abstract
The application of stem cell transplants in clinical practice has increased in frequency in recent years. Many of the stem cell transplants in neurologic diseases, including stroke, Parkinson disease, spinal cord injury, and demyelinating diseases, are unproven-they have not been tested in prospective, controlled clinical trials and have not become accepted therapies. Stem cell transplant procedures currently being carried out have therapeutic aims, but are frequently experimental and unregulated, and could potentially put patients at risk. In some cases, patients undergoing such operations are not included in a clinical trial, and do not provide genuinely informed consent. For these reasons and others, some current stem cell interventions for neurologic diseases are ethically dubious and could jeopardize progress in the field. We provide discussion points for the evaluation of new stem cell interventions for neurologic disease, based primarily on the new Guidelines for Stem Cell Research and Clinical Translation released by the International Society for Stem Cell Research in May 2016. Important considerations in the ethical translation of stem cells to clinical practice include regulatory oversight, conflicts of interest, data sharing, the nature of investigation (e.g., within vs outside of a clinical trial), informed consent, risk-benefit ratios, the therapeutic misconception, and patient vulnerability. To help guide the translation of stem cells from the laboratory into the neurosurgical clinic in an ethically sound manner, we present an ethical discussion of these major issues at stake in the field of stem cell clinical research for neurologic disease.
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Affiliation(s)
- David J Cote
- From Cushing Neurosurgery Outcomes Center, Department of Neurosurgery (D.J.C., T.R.S.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medical Humanities, Julius Center (A.L.B.), and Department of Neurosurgery (M.L.B.), University Medical Center, Utrecht, the Netherlands; Department of Neurosurgery (M.A.), Ohio State University, Columbus; Copenhagen Neurosurgery, Neuroscience Centre (J.B.), Rigshospitalet, University of Copenhagen, Denmark; University of Saskatchewan and Saskatoon Health Region, Department of Surgery (I.M.), and Royal University Hospital, Saskatoon, Canada; Department of Neurosurgery (A.S.A.), University of Dammam College of Medicine, Saudi Arabia; Department of Neurosurgery (N.B.), Göztepe Education and Research Hospital, Istanbul, Turkey; Department of Neurosurgery (G.B.), Denver Health Medical Center, University of Colorado School of Medicine; Department of Neurosurgery (I.N.E.), Ain Shams University, Cairo, Egypt; Department of Neurosurgery (T.M.), Karolinska Hospital and Institute, Stockholm, Sweden; and Department of Neurology (M.L.B.), Massachusetts General Hospital, Boston
| | - Annelien L Bredenoord
- From Cushing Neurosurgery Outcomes Center, Department of Neurosurgery (D.J.C., T.R.S.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medical Humanities, Julius Center (A.L.B.), and Department of Neurosurgery (M.L.B.), University Medical Center, Utrecht, the Netherlands; Department of Neurosurgery (M.A.), Ohio State University, Columbus; Copenhagen Neurosurgery, Neuroscience Centre (J.B.), Rigshospitalet, University of Copenhagen, Denmark; University of Saskatchewan and Saskatoon Health Region, Department of Surgery (I.M.), and Royal University Hospital, Saskatoon, Canada; Department of Neurosurgery (A.S.A.), University of Dammam College of Medicine, Saudi Arabia; Department of Neurosurgery (N.B.), Göztepe Education and Research Hospital, Istanbul, Turkey; Department of Neurosurgery (G.B.), Denver Health Medical Center, University of Colorado School of Medicine; Department of Neurosurgery (I.N.E.), Ain Shams University, Cairo, Egypt; Department of Neurosurgery (T.M.), Karolinska Hospital and Institute, Stockholm, Sweden; and Department of Neurology (M.L.B.), Massachusetts General Hospital, Boston
| | - Timothy R Smith
- From Cushing Neurosurgery Outcomes Center, Department of Neurosurgery (D.J.C., T.R.S.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medical Humanities, Julius Center (A.L.B.), and Department of Neurosurgery (M.L.B.), University Medical Center, Utrecht, the Netherlands; Department of Neurosurgery (M.A.), Ohio State University, Columbus; Copenhagen Neurosurgery, Neuroscience Centre (J.B.), Rigshospitalet, University of Copenhagen, Denmark; University of Saskatchewan and Saskatoon Health Region, Department of Surgery (I.M.), and Royal University Hospital, Saskatoon, Canada; Department of Neurosurgery (A.S.A.), University of Dammam College of Medicine, Saudi Arabia; Department of Neurosurgery (N.B.), Göztepe Education and Research Hospital, Istanbul, Turkey; Department of Neurosurgery (G.B.), Denver Health Medical Center, University of Colorado School of Medicine; Department of Neurosurgery (I.N.E.), Ain Shams University, Cairo, Egypt; Department of Neurosurgery (T.M.), Karolinska Hospital and Institute, Stockholm, Sweden; and Department of Neurology (M.L.B.), Massachusetts General Hospital, Boston
| | - Mario Ammirati
- From Cushing Neurosurgery Outcomes Center, Department of Neurosurgery (D.J.C., T.R.S.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medical Humanities, Julius Center (A.L.B.), and Department of Neurosurgery (M.L.B.), University Medical Center, Utrecht, the Netherlands; Department of Neurosurgery (M.A.), Ohio State University, Columbus; Copenhagen Neurosurgery, Neuroscience Centre (J.B.), Rigshospitalet, University of Copenhagen, Denmark; University of Saskatchewan and Saskatoon Health Region, Department of Surgery (I.M.), and Royal University Hospital, Saskatoon, Canada; Department of Neurosurgery (A.S.A.), University of Dammam College of Medicine, Saudi Arabia; Department of Neurosurgery (N.B.), Göztepe Education and Research Hospital, Istanbul, Turkey; Department of Neurosurgery (G.B.), Denver Health Medical Center, University of Colorado School of Medicine; Department of Neurosurgery (I.N.E.), Ain Shams University, Cairo, Egypt; Department of Neurosurgery (T.M.), Karolinska Hospital and Institute, Stockholm, Sweden; and Department of Neurology (M.L.B.), Massachusetts General Hospital, Boston
| | - Jannick Brennum
- From Cushing Neurosurgery Outcomes Center, Department of Neurosurgery (D.J.C., T.R.S.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medical Humanities, Julius Center (A.L.B.), and Department of Neurosurgery (M.L.B.), University Medical Center, Utrecht, the Netherlands; Department of Neurosurgery (M.A.), Ohio State University, Columbus; Copenhagen Neurosurgery, Neuroscience Centre (J.B.), Rigshospitalet, University of Copenhagen, Denmark; University of Saskatchewan and Saskatoon Health Region, Department of Surgery (I.M.), and Royal University Hospital, Saskatoon, Canada; Department of Neurosurgery (A.S.A.), University of Dammam College of Medicine, Saudi Arabia; Department of Neurosurgery (N.B.), Göztepe Education and Research Hospital, Istanbul, Turkey; Department of Neurosurgery (G.B.), Denver Health Medical Center, University of Colorado School of Medicine; Department of Neurosurgery (I.N.E.), Ain Shams University, Cairo, Egypt; Department of Neurosurgery (T.M.), Karolinska Hospital and Institute, Stockholm, Sweden; and Department of Neurology (M.L.B.), Massachusetts General Hospital, Boston
| | - Ivar Mendez
- From Cushing Neurosurgery Outcomes Center, Department of Neurosurgery (D.J.C., T.R.S.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medical Humanities, Julius Center (A.L.B.), and Department of Neurosurgery (M.L.B.), University Medical Center, Utrecht, the Netherlands; Department of Neurosurgery (M.A.), Ohio State University, Columbus; Copenhagen Neurosurgery, Neuroscience Centre (J.B.), Rigshospitalet, University of Copenhagen, Denmark; University of Saskatchewan and Saskatoon Health Region, Department of Surgery (I.M.), and Royal University Hospital, Saskatoon, Canada; Department of Neurosurgery (A.S.A.), University of Dammam College of Medicine, Saudi Arabia; Department of Neurosurgery (N.B.), Göztepe Education and Research Hospital, Istanbul, Turkey; Department of Neurosurgery (G.B.), Denver Health Medical Center, University of Colorado School of Medicine; Department of Neurosurgery (I.N.E.), Ain Shams University, Cairo, Egypt; Department of Neurosurgery (T.M.), Karolinska Hospital and Institute, Stockholm, Sweden; and Department of Neurology (M.L.B.), Massachusetts General Hospital, Boston
| | - Ahmed S Ammar
- From Cushing Neurosurgery Outcomes Center, Department of Neurosurgery (D.J.C., T.R.S.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medical Humanities, Julius Center (A.L.B.), and Department of Neurosurgery (M.L.B.), University Medical Center, Utrecht, the Netherlands; Department of Neurosurgery (M.A.), Ohio State University, Columbus; Copenhagen Neurosurgery, Neuroscience Centre (J.B.), Rigshospitalet, University of Copenhagen, Denmark; University of Saskatchewan and Saskatoon Health Region, Department of Surgery (I.M.), and Royal University Hospital, Saskatoon, Canada; Department of Neurosurgery (A.S.A.), University of Dammam College of Medicine, Saudi Arabia; Department of Neurosurgery (N.B.), Göztepe Education and Research Hospital, Istanbul, Turkey; Department of Neurosurgery (G.B.), Denver Health Medical Center, University of Colorado School of Medicine; Department of Neurosurgery (I.N.E.), Ain Shams University, Cairo, Egypt; Department of Neurosurgery (T.M.), Karolinska Hospital and Institute, Stockholm, Sweden; and Department of Neurology (M.L.B.), Massachusetts General Hospital, Boston
| | - Naci Balak
- From Cushing Neurosurgery Outcomes Center, Department of Neurosurgery (D.J.C., T.R.S.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medical Humanities, Julius Center (A.L.B.), and Department of Neurosurgery (M.L.B.), University Medical Center, Utrecht, the Netherlands; Department of Neurosurgery (M.A.), Ohio State University, Columbus; Copenhagen Neurosurgery, Neuroscience Centre (J.B.), Rigshospitalet, University of Copenhagen, Denmark; University of Saskatchewan and Saskatoon Health Region, Department of Surgery (I.M.), and Royal University Hospital, Saskatoon, Canada; Department of Neurosurgery (A.S.A.), University of Dammam College of Medicine, Saudi Arabia; Department of Neurosurgery (N.B.), Göztepe Education and Research Hospital, Istanbul, Turkey; Department of Neurosurgery (G.B.), Denver Health Medical Center, University of Colorado School of Medicine; Department of Neurosurgery (I.N.E.), Ain Shams University, Cairo, Egypt; Department of Neurosurgery (T.M.), Karolinska Hospital and Institute, Stockholm, Sweden; and Department of Neurology (M.L.B.), Massachusetts General Hospital, Boston
| | - Gene Bolles
- From Cushing Neurosurgery Outcomes Center, Department of Neurosurgery (D.J.C., T.R.S.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medical Humanities, Julius Center (A.L.B.), and Department of Neurosurgery (M.L.B.), University Medical Center, Utrecht, the Netherlands; Department of Neurosurgery (M.A.), Ohio State University, Columbus; Copenhagen Neurosurgery, Neuroscience Centre (J.B.), Rigshospitalet, University of Copenhagen, Denmark; University of Saskatchewan and Saskatoon Health Region, Department of Surgery (I.M.), and Royal University Hospital, Saskatoon, Canada; Department of Neurosurgery (A.S.A.), University of Dammam College of Medicine, Saudi Arabia; Department of Neurosurgery (N.B.), Göztepe Education and Research Hospital, Istanbul, Turkey; Department of Neurosurgery (G.B.), Denver Health Medical Center, University of Colorado School of Medicine; Department of Neurosurgery (I.N.E.), Ain Shams University, Cairo, Egypt; Department of Neurosurgery (T.M.), Karolinska Hospital and Institute, Stockholm, Sweden; and Department of Neurology (M.L.B.), Massachusetts General Hospital, Boston
| | - Ignatius Ngene Esene
- From Cushing Neurosurgery Outcomes Center, Department of Neurosurgery (D.J.C., T.R.S.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medical Humanities, Julius Center (A.L.B.), and Department of Neurosurgery (M.L.B.), University Medical Center, Utrecht, the Netherlands; Department of Neurosurgery (M.A.), Ohio State University, Columbus; Copenhagen Neurosurgery, Neuroscience Centre (J.B.), Rigshospitalet, University of Copenhagen, Denmark; University of Saskatchewan and Saskatoon Health Region, Department of Surgery (I.M.), and Royal University Hospital, Saskatoon, Canada; Department of Neurosurgery (A.S.A.), University of Dammam College of Medicine, Saudi Arabia; Department of Neurosurgery (N.B.), Göztepe Education and Research Hospital, Istanbul, Turkey; Department of Neurosurgery (G.B.), Denver Health Medical Center, University of Colorado School of Medicine; Department of Neurosurgery (I.N.E.), Ain Shams University, Cairo, Egypt; Department of Neurosurgery (T.M.), Karolinska Hospital and Institute, Stockholm, Sweden; and Department of Neurology (M.L.B.), Massachusetts General Hospital, Boston
| | - Tiit Mathiesen
- From Cushing Neurosurgery Outcomes Center, Department of Neurosurgery (D.J.C., T.R.S.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medical Humanities, Julius Center (A.L.B.), and Department of Neurosurgery (M.L.B.), University Medical Center, Utrecht, the Netherlands; Department of Neurosurgery (M.A.), Ohio State University, Columbus; Copenhagen Neurosurgery, Neuroscience Centre (J.B.), Rigshospitalet, University of Copenhagen, Denmark; University of Saskatchewan and Saskatoon Health Region, Department of Surgery (I.M.), and Royal University Hospital, Saskatoon, Canada; Department of Neurosurgery (A.S.A.), University of Dammam College of Medicine, Saudi Arabia; Department of Neurosurgery (N.B.), Göztepe Education and Research Hospital, Istanbul, Turkey; Department of Neurosurgery (G.B.), Denver Health Medical Center, University of Colorado School of Medicine; Department of Neurosurgery (I.N.E.), Ain Shams University, Cairo, Egypt; Department of Neurosurgery (T.M.), Karolinska Hospital and Institute, Stockholm, Sweden; and Department of Neurology (M.L.B.), Massachusetts General Hospital, Boston
| | - Marike L Broekman
- From Cushing Neurosurgery Outcomes Center, Department of Neurosurgery (D.J.C., T.R.S.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medical Humanities, Julius Center (A.L.B.), and Department of Neurosurgery (M.L.B.), University Medical Center, Utrecht, the Netherlands; Department of Neurosurgery (M.A.), Ohio State University, Columbus; Copenhagen Neurosurgery, Neuroscience Centre (J.B.), Rigshospitalet, University of Copenhagen, Denmark; University of Saskatchewan and Saskatoon Health Region, Department of Surgery (I.M.), and Royal University Hospital, Saskatoon, Canada; Department of Neurosurgery (A.S.A.), University of Dammam College of Medicine, Saudi Arabia; Department of Neurosurgery (N.B.), Göztepe Education and Research Hospital, Istanbul, Turkey; Department of Neurosurgery (G.B.), Denver Health Medical Center, University of Colorado School of Medicine; Department of Neurosurgery (I.N.E.), Ain Shams University, Cairo, Egypt; Department of Neurosurgery (T.M.), Karolinska Hospital and Institute, Stockholm, Sweden; and Department of Neurology (M.L.B.), Massachusetts General Hospital, Boston.
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Balak N, Duman E, Durmusalioglu I, Bosnak E. Combined use of OsiriX™ imaging software and ultrasound to guide surgery in a patient with a needle in the head. Interdisciplinary Neurosurgery 2016. [DOI: 10.1016/j.inat.2016.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Aras AB, Guven M, Balak N, Ayan E, Uyar SB, Elmaci I. Evaluation of the Association Between Matrix Metalloproteinase 11 and Intervertebral Disc Disease. Turk Neurosurg 2016; 26:274-9. [PMID: 26956825 DOI: 10.5137/1019-5149.jtn.12762-14.0] [Citation(s) in RCA: 2] [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] [Indexed: 10/24/2022]
Abstract
AIM The intervertebral disc starts to degenerate when a human being begins to stand and learn to walk. It is known that many extrinsic, intrinsic and genetic factors play a role in disc degeneration. In this study, we examined whether the matrix metalloproteinase 11 might be associated with intervertebral disc degeneration. MATERIAL AND METHODS Fifty-six patients with lumbar disc herniations who were operated at Göztepe Education and Research Hospital, Neurosurgery Clinic between September 2008 and December 2009 were prospectively reviewed. History and complaints were obtained from the case reports. Neuroradiological evaluation was performed with magnetic resonance imaging. Surgical findings of cases were reported in the operation notes. Microscopic posterior hemipartial laminectomy and discectomy were performed in all cases. Degenerated herniated disc material of all cases extracted during surgery was evaluated with immunohistochemical staining in Marmara University, Institute of Neurological Sciences, Pathology Laboratory. RESULTS Comparing the immunohistochemical staining of cases who were 50 years or younger and cases who were over 50 years old, statistical significance was determined. CONCLUSION Matrix metalloproteinase 11 has a role in degenerating intervertebral disc disease, but it is not the only factor. Matrix metalloproteinase 11 might be a genetic factor in young-middle aged patients.
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Affiliation(s)
- Adem Bozkurt Aras
- Canakkale Onsekiz Mart University, School of Medicine, Department of Neurosurgery, Canakkale, Turkey
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Altaş M, Cerçi A, Silav G, Sari R, Coşkun K, Balak N, Işik N, Elmaci I. Microsurgical management of non-neurofibromatosis spinal schwannoma. Neurocirugia (Astur) 2012; 24:244-9. [PMID: 23102980 DOI: 10.1016/j.neucir.2012.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 07/28/2011] [Accepted: 01/17/2012] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The aim of this study is to assess the clinical properties and surgical results of patients diagnosed with spinal schwannomas without neurofibromatosis (NF) properties. PATIENTS AND METHODS The data obtained from 35 patients who underwent resection of spinal schwannomas were analyzed. All cases with neurofibromas and those with a known diagnosis of NF Type 1 or 2 were excluded. 35 patients underwent surgery for spinal schwannoma at our institution between January 1997 and 2010. The data were gathered retrospectively from medical records and included clinical presentation, tumor location and post-operative complications. All cases were surgically excised, and they were confirmed to be schwannomas by pathologists with histopathological sections in paraffin stained with hematoxylin-eosin. RESULT We treated 35 (20 males and 15 females) patients with spinal schwannomas. The mean age of the patients was 47.2 (between 13 and 76) years. Of the cases, six schwannomas were located in the cervical spine, four in the thoracic spine, two in cervico-thoracic area, 10 in the thoraco-lumbar area and 13 in the lumbar spine. Two patients had malignant schwannomas that were recurrent. Of the 35 cases, the schwannomas were intradural-extramedullary in 30 cases (86%), intradural-intramedullar in 2 cases (6%), and extradural in 3 cases (9%). CONCLUSION Spinal schwannomas may occur at any level of the spinal axis and are most frequently intradural-extramedullary. The most common clinical presentation is pain. Most of the spinal schwannomas in non-NF patients can be resected completely without or with minor post-operative deficits. This knowledge may help us to create a strategy for total resection of a spinal schwannomas.
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Affiliation(s)
- Murat Altaş
- Department of Neurosurgery, Tayfur Ata Sokmen Medical Faculty, Mustafa Kemal University, Hatay, Turkey.
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Turkoglu R, Balak N. Atypical presentation of orbital pseudotumor with visual loss as an initial manifestation. J Clin Neurol 2011; 7:50-2. [PMID: 21519529 PMCID: PMC3079162 DOI: 10.3988/jcn.2011.7.1.50] [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: 04/13/2010] [Revised: 07/06/2010] [Accepted: 07/06/2010] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND An orbital pseudotumor typically presents with periorbital pain, cranial nerve palsies and proptosis. Although visual deterioration is not unexpected in this pathology, its presentation solely with visual loss is unusual. CASE REPORT In this short report, we summarize a case of orbital pseudotumor which presented solely with a decrease in visual acuity, and discuss the clinical and radiological findings. CONCLUSIONS This atypical presentation likely resulted from the orbital pseudotumor originating in the optic foramen, leaving the neurovascular structures of the superior orbital fissure untouched initially. In the early clinical period, an orbital pseudotumor may manifest itself solely by visual loss. It should therefore be included in the differential diagnosis of visual pathologies-even in the absence of orbital pain and symptoms related to ocular movements.
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Affiliation(s)
- Recai Turkoglu
- Department of Neurology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
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Prajsnar A, Balak N, Walter GF, Stan AC, Deinsberger W, Tapul L, Bayindir C. Recurrent paraganglioma of Meckel's cave: Case report and a review of anatomic origin of paragangliomas. Surg Neurol Int 2011; 2:45. [PMID: 21660268 PMCID: PMC3108444 DOI: 10.4103/2152-7806.79763] [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] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 03/22/2011] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Paragangliomas are rare, usually benign tumors of neural crest origin. They account for only 0.6% of all head and neck tumors. In the craniocervical area, they are more common in the carotid body and tympanico-jugular regions. To the authors' knowledge, a case of paraganglioma in Meckel's cave has not yet been reported in the medical literature. The pathogenesis and natural history of paragangliomas are still not well understood. We present a case of recurrent paraganglioma in Meckel's cave. CASE DESCRIPTION A 53-year-old woman was diagnosed with trigeminal neuralgia, dysesthesia and hypoesthesia on the left side of the face, hearing disturbance and a history of chronic, persistent temporal headaches. Magnetic resonance imaging (MRI) showed a lesion located in Meckel's cave on the left side, extending to the posterior cranial fossa and compressing the left cerebral peduncle. The lesion was first thought to be a recurrence of an atypical meningioma, as the pathologist described it in the tissue specimen resected 3 years earlier, and a decision for re-operation was made. A lateral suboccipital approach to the lesion was used under neuronavigational guidance. The tumor was removed, and histological examination proved the lesion to be a paraganglioma. Five months later, the follow-up MRI showed local regrowth, which required subsequent surgical intervention. CONCLUSIONS A paraganglioma in Meckel's cave is an uncommon tumor in this location. Although ectopic paragangliomas have been described in the literature, a paraganglioma atypically located in Meckel's cave makes a topographic correlation difficult, mainly because paraganglionic cells are usually not found in Meckel's cave. Another peculiarity of the case is the local recurrence of the tumor in a relatively short time despite an attempted, almost gross total resection.
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Affiliation(s)
- Anna Prajsnar
- Department of Neurosurgery, Klinikum Kassel, Kassel, Germany
| | - Naci Balak
- Goztepe Education and Research Hospital, Istanbul, Turkey
| | | | | | | | - Leyla Tapul
- Department of Histology, Istanbul Faculty of Medicine, University of Istanbul, Turkey
| | - Cicek Bayindir
- Department of Neuropathology, Istanbul Faculty of Medicine, University of Istanbul, Turkey
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Balak N, Bolukbasi FH, Senol M, Zemheri E, Aslan B, Kösemetin D, Isik N. Parieto-occipital epidural hydatid cyst. Clin Neuroradiol 2011; 21:157-61. [PMID: 21210074 DOI: 10.1007/s00062-010-0048-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2010] [Accepted: 12/02/2010] [Indexed: 01/08/2023]
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Balak N, Demirkesen O, Efendioglu M, Bolukbasi FH, Basaran R, Onoz M, Aslan B, Tasel B, Cimen S, Isik N. Diagnostic approach to reveal retroperitoneal injury during lumbar discectomy. J Neurosurg Sci 2010; 54:129-133. [PMID: 21423082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
For decades, lumbar discectomy has been one of the most common surgical practices performed by neurosurgeons. Although it has proved to be an effective and safe surgical procedure, life threatening complications may occur in rare cases, including iliac artery and/or vein injuries, superior rectal artery injury, common iliac artery aneurysms, iliac arteriovenous fistula, intestinal injuries, and ureteral injuries. Ureteral damage during the lumbar L4-5 microdiscectomy was reported in a slim 50 year-old male patient. Because of a small amount of bleeding occurred during the surgery as soon as the patient came out of anesthesia, an angio-computed tomography (CT) of the abdomen was performed. It showed no hematoma and no major vascular injury, but air bubbles were seen in the retroperitoneal region, indicating that perforation had occurred. The patient was then monitored carefully for immediate and possible subsequent injuries, in this way; ureteral damage was found and repaired. This is perhaps the first such case report in the literature of the early detection of ureteral damage using an angio CT scan. If there is a suspicion of perforation of the anterior annulus fibrosus and anterior longitudinal ligaments but no indication for an emergency laparotomy, an abdominal angio CT done immediately after the surgery and an abdominal non-contrast CT 4 hours later will give sufficient information concerning the potential occurrence of nearly all the major complications associated with lumbar discectomy.
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Affiliation(s)
- N Balak
- Department of Neurosurgery, Göztepe Education and Research Hospital, Istanbul, Turkey.
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Tamtögl A, Mayrhofer-Reinhartshuber M, Balak N, Ernst WE, Rieder KH. Elastic and inelastic scattering of He atoms from Bi(111). J Phys Condens Matter 2010; 22:304019. [PMID: 21399351 DOI: 10.1088/0953-8984/22/30/304019] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Elastic and inelastic scattering of helium atoms has been used to study the Bi(111) surface. Sharp diffraction peaks are found with results in excellent agreement with previous structure determinations of the Bi(111) surface. The rather large first order peaks with respect to the zero order peak indicate a stronger surface corrugation than observed in helium scattering from other metallic surfaces. Time-of-flight spectra of scattered He atoms clearly reveal two inelastic scattering maxima, which allow a first report on phonon creation and annihilation events on the Bi(111) surface. An estimate of the group velocity shows that the phonon creation peak is likely to correspond to a Rayleigh mode.
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Affiliation(s)
- A Tamtögl
- Institute of Experimental Physics, Graz University of Technology, Graz, Austria.
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Isik N, Elmaci I, Gokben B, Balak N, Tosyali N. Currarino triad: surgical management and follow-up results of four [correction of three] cases. Pediatr Neurosurg 2010; 46:110-9. [PMID: 20664237 DOI: 10.1159/000319007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [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: 10/19/2009] [Accepted: 04/28/2010] [Indexed: 11/19/2022]
Abstract
The Currarino syndrome is a rare triad that is a combination of a presacral mass, a congenital sacral bony abnormality and an anorectal malformation. We present 4 children with complete Currarino triad who were diagnosed using MRI. Our aim was to report the neurosurgical management of Currarino syndrome in children. All of the patients had chronic constipation and pain in the lumbosacral region. In the plain radiograph, 3 patients had a sacral scimitar-shaped bony abnormality, and 1 patient had total sacral agenesis. There was a narrow anal canal or narrow ventrally displaced anus in all patients. Their anorectal malformations were characterized as anal stenoses (4 patients), associated with Hirschsprung's disease in 2 cases. In 3 patients, MRI showed tethered cord syndrome in addition to the presacral mass. There was hydrocephalus in 1 patient. Anal stenosis was treated by anal dilatation. In 2 patients, rectal biopsy and temporary colostomy (2 patients) had been performed previously due to Hirschsprung's disease. We performed a posterior procedure via lumbar and sacral partial laminectomy-laminoplasty and transdural ligation of the neck of the meningocele for anterior sacral meningoceles, or alternatively, tumor excision for other types of presacral lesions. Histopathologically, 3 were cases of anterior sacral meningoceles and 1 was a teratoma. One of them also had a spinal abscess. He required reoperation (twice) and appeared at the time to have improved with medical therapy. All patients improved and stabilized. There were no additional neurological deficits and no recurrence of the presacral mass over the follow-up period (6 years, on average). The family pedigree did not reveal any familial transmission pattern. In cases of Currarino triad, MRI can allow the characterization of the presacral masses. If it is an anterior sacral meningocele or a solid tumor without severe anorectal malformation, it can be managed with posterior lumbar and sacral procedures. Such approaches are performed easily by transdural ligation of the neck of the anterior sacral meningocele or through tumor excision.
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Affiliation(s)
- Nejat Isik
- Department of Neurosurgery, Goztepe Research and Education Hospital, Istanbul, Turkey. nejatisik @ hotmail.com
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Balak N, Ersoy G, Uslu Ü, Tanriöver N, Tapul L, Çetin G, Işik N, Elmaci I. Microsurgical and histomorphometric study of the occipital sinus: Quantitative measurements using a novel approach of stereology. Clin Anat 2010; 23:386-93. [DOI: 10.1002/ca.20947] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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