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Öğe Challenges in the clinical and radiological differential diagnosis of cerebrovascular events and malignant primary brain tumors: reports from a retrospective case series(Turkish Neurosurgical Society, 2020) Civelek, Erdinç; Akyuva, Yener; Kaplan, Necati; Diren, Furkan; Boyalı, Osman; Kabataş, SerdarAIM: To reveal difficulties in differential diagnosis of some cases of cerebrovascular events (CVEs) and malignant primary brain tumors (MBTs) even a multidiciplinary evaluation in grand rounds. MATERIAL and METHODS: This study retrospectively analyzed the patient archives from January 2017–December 2019. The records of 572 patients discussed in these meetings were examined. A total of 8 patients having a challenge in differential diagnosis were detected. RESULTS: This study has included 8 cases in which neurology−neurosurgery−neuroradiology clinicians have difficulty in differentiating CVE and MBT. In the present study, three patients were evaluated with a preliminary diagnosis of hemorrhagic CVE in the emergency room. Since degradation products of hemoglobin have prevented advanced imaging methods to diagnose in two patients, these patients have been followed closely. The correct diagnosis could be made through the scan performed during control follow-ups The preliminary diagnosis of seven patients was CVE, but they received the MBT diagnosis during the follow-up. One patient was thought to have MBT initially; however, he/she was diagnosed with CVE after an advanced examination and close follow-up. CONCLUSION: Despite developing medical imaging methods and diagnostic studies, there are still some difficulties in making differential diagnosis of CVEs and MBTs. In some patients, further examination and imaging methods may be needed such as magnetic resonance imaging-spectroscopy (MRI-S), perfusion magnetic resonance imaging (Per-MRI), digital substratioangiography (DSA). Despite all these neuroradiological examinations and multidiciplinary evaluation, distinction between CVE and MBT may be difficult, and medicolegal problems may be encountered.Öğe Complications of Cervical Disc Prosthesis Dislocation: A Retrospective Clinical Study(Galenos Yayincilik, 2021) Akyuva, Yener; Ozger, Ozkan; Urfali, Boran; Kaplan, Necati; Aykut, Ali MaksutObjective: The most commonly used method for the surgical treatment of cervical disc herniation (CDH) is anterior disc excision with Smith-Robinson's approach. Following the excision of pathological disc space, disc prosthesis is placed if a continuation of dynamic movement in the disc space is desired and a cervical cage is placed for the purpose of fusion. Cervical disc prosthesis seems superior to cervical cage; however, it is not suitable for every patient and can cause serious complications. Our study include data of patients who developed complications following the dislocation of cervical prosthesis and who were referred to our clinic. The aim of our study is to emphasize that the cervical prosthesis is not suitable for every patient and may cause serious complications. Methods: Data of the patients who were operated due to the diagnosis of CDH in other centers and underwent revision surgery for the development of cervical prosthesis dislocation between 2013 and 2020 were collected. Results: This study analysed the data of four male and three female patients. The median value of patient ages was 42 (28-53). Neck pain and swallowing difficulty were the most common reasons for admission to the clinic. Dislocation was found to develop after trauma in three patients. Anterior and posterior dislocations were found to develop in five and two patients, respectively. Seven patients underwent revision surgery. All these patients were found to have dislocations at the C5-6 level. Conclusion: The prosthesis to be placed in the surgical treatment of CDH should be determined based on the patient. Detailed information should be provided to the patient for whom cervical disc prosthesis is to be placed and prosthesis of the most appropriate size for disc space should be placed properly.Öğe Lumbar Disc Herniation Might Spontaneously Regress, While NeuropathicPain Might Start: Retrospective Clinical Study(2020) Akyuva, Yener; Kaplan, Necati; Urfalı, Boran; Özger, Özkan; Civelek, Erdinç; Kabataş, Serdar; Serasrlan, YurdalLumbar disc herniation (LDH) is a common cause of low back pain and radicular pain. The aim of our study was to evaluate the regression of LDH in patients who are considered to require surgical treatment but prefer conservative treatment. Patients who presented between January 2018 and June 2020 and who did not accept the recommended surgical treatment following a diagnosis of LDH based on clinical and radiological findings were retrospectively reviewed. All 12 of the patients included in the study showed spontaneous regression of LDH during outpatient clinical follow-up. Our study included 12 patients (seven male and five female). The mean age was 46.5 (the youngest was 30 years old; the oldest was 70 years old). Regression was observed at the L2-L3 level in two patients (10%), at the L4-L5 level in four patients (40%), and at the L5-S1 level in six patients (50%). On the follow-up examination of all patients, the severity of their pain was evaluated with the Visual Analogue Scale, and all patients described a reduction in pain (min: 2, max: 8). Ten patients described radicular pain at the initial examination, eight patients received physical therapy and rehabilitation treatment before the follow-up examination, and nine patients described neuropathic pain at the follow-up examination. Spontaneous regression of LDH is rare. While conservative treatments provided partial improvement in the complaints of these patients, conservative treatments usually cannot prevent the development of neuropathic pain.Öğe Phase I study on the safety and preliminary efficacy of allogeneic mesenchymal stem cells in hypoxic-ischemic encephalopathy(Baishideng Publishing Group Co, 2021) Kabataş, Serdar; Civelek, Erdinç; Kaplan, Necati; Savrunlu, Eyüp Can; Sezen, Gülseli Berivan; Chasan, Mourat; Can, HalilBACKGROUND Hypoxic-ischemic encephalopathy (HIE) is a leading cause of morbidity and mortality in the adult as well as in the neonate, with limited options for treatment and significant dysfunctionality. AIM To investigate the safety and preliminary efficacy of allogeneic mesenchymal stem cells (MSCs) in HIE patients. METHODS Patients who had HIE for at least 6 mo along with significant dysfunction and disability were included. All patients were given Wharton's jelly-derived MSCs at 1 × 106/kg intrathecally, intravenously, and intramuscularly twice a month for two months. The therapeutic effects and prognostic implications of MSCs were evaluated by multiple follow-ups. Functional independence measure (FIM), modified Ashworth, and Karnofsky scales were used to assess any side effects, neurological and cognitive functions, and overall outcomes. RESULTS The 8 subjects included in the study had a mean age of 33.25 ± 10.18 years. Mean HIE exposure and mean post-HIE durations were 45.63 ± 10.18 and 19.67 ± 29.04 mo, respectively. Mean FIM score was 18.38 ± 1.06, mean modified Ashworth score was 43.5 ± 4.63, and mean Karnofsky score was 20. For the first 24 h, 5 of the patients experienced a subfebrile state, accompanied by mild headaches due to intrathecally administration and muscle pain because of intramuscularly administration. Neurological and functional examinations, laboratory tests, electroencephalography, and magnetic resonance imaging were performed to assess safety of treatment. Mean FIM score increased by 20.88 ± 3.31 in the first month (P = 0.027) and by 31.38 ± 14.69 in 12 mo (P = 0.012). The rate of patients with an FIM score of 126 increased from 14.58% to 16.57% in the first month and 24.90% in 12 mo. CONCLUSION Multiple triple-route Wharton's jelly-derived MSC administrations were found to be safe for HIE patients, indicating neurological and functional improvement. Based on the findings obtained here, further randomized and placebo research could be performed. © The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
