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Öğe Analysis of the effects of subthalamic nucleus deep brain stimulation on somatosensation in Parkinson's disease patients(Springer-Verlag Italia Srl, 2020) Huzmeli, Esra Dogru; Yilmaz, Atilla; Okuyucu, EsraObjective Despite the subthalamic nucleus (STN) deep brain stimulation (DBS) is a treatment commonly used to ameliorate the motor symptoms of Parkinson's disease (PD), its effects on somatosensation is unclear. The purpose of this study was to investigate the potential effects of DBS on temperature, proprioceptive, tactile, exteroceptive, pain and cortical sensations, and odor identification in PD patients. Methods The study included 14 patients (with a mean age of 59.78 +/- 11.03 years; range, 44-70 years) with idiopathic PD who underwent DBS surgery for movement disorders caused by PD at the same Neurosurgery Department. All patients were tested while DBS was turned on (DBS-ON) and off (DBS-OFF). To clearly observe the effect of removing stimulation off, DBS devices were turned off by experimental clinical personnel for a minimum duration of 30 min prior to examination. Temperature, proprioceptive, tactile, exteroceptive, pain and cortical sensations, and odor identification were examined. Results We found that two-point discrimination was significantly lower during DBS-ON than DBS-OFF (p = 0.031). Tactile sensation and kinesthesia deviation degree were lower during DBS-ON than DBS-OFF, but were non-significant (p > 0.05). The number of correct answers on an assessment of graphesthesia was higher during DBS-ON, but was non-significant as well (p > 0.05). Odor identification was better during DBS-OFF. Conclusions DBS may have an effective role to improve somatosensation and DBS-related benefits may not be explained by improvements in motor function alone, but rather by enhanced somatosensory processing. Further studies with larger study groups are needed.Öğe Calcified chronic subdural hematoma(2012) Aras, Mustafa; Altaş, Murat; Yilmaz, Atilla; Serarslan, Yurdal; Urfali, Boran; Yilmaz, NebiCalcified subdural hematoma is a rarely seen event. It may develop secondary to previous trauma or inappropriate surgical procedures. Due to the not well understood etiology, there are variations in the treatment choices. We present a 27-year old male patient with calcified chronic subdural hematoma. He was operated on following an motorcycle accident in another hospital 5 years ago. He was admitted to our hospital complaining about seizure, headache and dizziness. Neuroradiological examination revealed a calcified chronic subdural hematoma was detected on the right hemisphere. The patient was hospitalized and put on anti-epileptic and analgesic drugs. Any surgical treatment was not applied. In cases with calcified chronic subdural hematoma, the decision of surgical operation should be decided after a carefully and meticulously investigation. It should be avoided any profitless and likely harmful surgical procedures. The clinical observation may be appropriate in the determination of treatment approaches. © 2012 OMU.Öğe A case with essential tremor refractory to medication successfully treated with deep brain stimulation(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2018) Yilmaz, Atilla; Yildizgoren, Mustafa Turgut; Okuyucu, Emine Esra[Abstract Not Available]Öğe Clinical and Demographic Characteristics of Patients Who Were Treated with Kyphoplasty Due to Osteoporotic Fracture(Galenos Yayincilik, 2017) Yilmaz, Atilla; Yildizgoren, Mustafa Turgut; Oral, Sukru; Serarslan, YurdalObjective: The aim of this study is to determine the demographic and clinical characteristics of patients who underwent kyphoplasty due to osteoporotic fractures. Materials and Methods: This retrospective study included 55 patients who underwent kyphoplasty due to osteoporotic fracture between the years 2011 and 2014. The patients divided into two groups according to their ages (under/over 65 years), and divided into three groups according to fracture regions (T10 and above; between T11-L1; L2 and under). Thus the age and gender distributions of the patients were made. Resting pain scores of all patients were determined by using visual analog scale (VAS) and daily life activities by Oswetry Disability Index (ODI) before and in the first month of treatment. Results: Seventeen of the all patients were male (30.9%) and 38 were female (69.1%), with a mean age of 69.9 +/- 8.7 years (between 50-88 ages). 90% of the patients older than 65 years had fracture in T11 and below. In 45.5% of all patients, the fracture was in the T11-L1 (thoracolomber junction) region. Resting VAS and ODI scores significantly improved from 8.7 +/- 1.5 to 2.1 +/- 1.2 and 44.7 +/- 7.2 to 15.4 +/- 3.5 respectively in the first month after kyphoplasty (p<0.05). Kyphoplasty material extravasated to the disc space in 7 (12.7%) patients and in 4 (7.3%) patients to cerebrospinal fluid. Conclusion: Osteoporotic fractures affect patients over 65 years of age and are frequently occur in the thoracolumbar junction and lower vertebras. Kyphoplasty is a minimally invasive treatment option to relieve pain and to improve functional status.Öğe Complications of 2-Level Dynamic Stabilization: A Correlative Clinical and Radiological Analysis at Two-Year Follow-up on 103 Patients(Turkish Neurosurgical Soc, 2018) Ciplak, Necati Mert; Suzer, Tuncer; Senturk, Salim; Yaman, Onur; Sasani, Mehdi; Oktenoglu, Tunc; Yilmaz, AtillaAIM: To investigate the postoperative complications, such as screw loosening, screw breakage and adjacent segment disease (ASD), in patients who underwent surgery with 2-level dynamic stabilization systems. MATERIAL and METHODS: Postoperative complications, clinical improvements and radiological parameters in patients who underwent surgery using a dynamic system for 2-level lumbar stabilization were retrospectively reviewed. A total of 103 patients with lumbar degenerative spinal instability underwent 2-level dynamic stabilization. Clinical findings were reviewed at 2-year follow-up. Screw breakage and loosening were evaluated during this duration together with clinical findings. RESULTS: Visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were significantly decreased at the four-month evaluation, and they were also decreased at the 1-year follow up and at the 24th postoperative month. ASD was diagnosed in twelve (8 females, 4 males) of the 103 patients in the follow-up radiological and clinical controls. There were 9 screw breakages and 4 screw loosening cases. The complication rate of 2-level dynamic stabilization was high in this study. CONCLUSION: Our results showed that complications (screw loosening or breakage and adjacent segment disease) are not rare after 2-level dynamic stabilization, unlike the acceptable results with the single-level dynamic system. The most probable explanation is that the instrument system behaves more rigidly with every additional segment.Öğe Disc Rehydration after Dynamic Stabilization: A Report of 59 Cases(Korean Soc Spine Surgery, 2017) Yilmaz, Atilla; Senturk, Salim; Sasani, Mehdi; Oktenoglu, Tunc; Yaman, Onur; Yildirim, Hakan; Suzer, TuncerStudy Design: A retrospective study investigating decrease in the nucleus pulposus signal intensity or disc height on magnetic resonance imaging (MRI) and disc degeneration. Purpose: Although a degenerated disc cannot self- regenerate, distraction or stabilization may provide suitable conditions for rehydration and possible regeneration. This study aimed to evaluate clinical outcomes and disc regeneration via MRI in a series of patients with degenerative disc disease (DDD) who underwent lumbar stabilization with a dynamic stabilization system (DSS). Overview of Literature: A dynamic system provides rehydration during early DDD. Methods: Fifty- nine patients (mean age, 46.5 years) who undedwent stabilization with DSS for segmental instability (painful black disc) between 2004 and 2014 were retrospectively evaluated. All patients underwent MRI preoperatively and 12 months postoperatively. Intervertebral disc (IVD) degeneration grades at the implanted segment were categorized using the Pfirrmann classification system. Patients were followed for a mean of 6.4 years, and clinical outcomes were based on visual analog scale (VAS) and Oswestry disability index (ODI) scores. Results: Significant improvements in back pain VAS and ODI scores from before surgery (7 and 68%, respectively) were reported at 6 (2.85 and 27.4%, respectively) and 12 months postoperatively (1.8 and 16.3%, respectively). Postoperative IVD changes were observed in 28 patients. Improvement was observed in 20 patients (34%), whereas progressive degeneration was observed in eight patients (13.5%). Thirty- one patients (52.5%) exhibited neither improvement nor progression. Single Pfirrmann grade improvements were observed in 29% of the patients and two- grade improvements were observed in 5%. Conclusions: Our observations support the theory that physiological movement and a balanced load distribution are necessary for disc regeneration. We conclude that DSS may decelerate the degeneration process and appears to facilitate regeneration.Öğe Does subthalamic nucleus deep brain stimulation affect the static balance at different frequencies?(Elsevier Espana Slu, 2023) Oz, Fatma; Yucekeya, Bircan; Huzmeli, Irem; Yilmaz, AtillaPurpose: To investigate the effects of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) with different stimulation frequencies on static balance. Materials and methods: Twenty patients (15 males and 5 females), aged between 43 and 81 (mean: 60.05 +/- 7.4) years, who had been diagnosed with idiopathic Parkinson's disease (PD) and undergone STN-DBS surgery were included in the study. Static balance was assessed with TecnoBody Rehabilitation System at four different frequencies: 230, 130, 90 and 60 Hz and off-stimulation. Static balance tests were 'stabilometric test, stabilometric compared bipedal closed/opened eye, stabilometric compared mono pedal (right/left foot)'. These tests reported the centre of pressure data 'ellipse area, perimeter, front/back and mediolateral standard deviations'. Results: There were no statically differences between the static balance test results at any frequency (p > 0.05), but results were found better at 90 Hz. Stabilometric compared bipedal opened eye forward-backward standard deviation result was significant between off -stimulation and 130 Hz (p = 0.04). Different frequency stimulation affected the static balance categories percentage with no statistical significance between off-stimulation and others (all p > 0.05). Conclusion: This study showed that STN-DBS did not affect the static balance negatively. Low -frequency (LF) stimulation improved the static equilibrium. Posturography systems will give more precise and quantitative results in similar studies with wide frequency ranges. (c) 2022 Sociedad Espa nola de Neurocirugi ' a. Published by Elsevier Espa n similar to a, S.L.U. All rights reserved.Öğe High Infection Rates in Patients with Long-Segment Dynesys System(Elsevier Science Inc, 2018) Akyoldas, Goktug; Yilmaz, Atilla; Aydin, Ahmet Levent; Oktenoglu, Tunc; Sasani, Mehdi; Suzer, Tuncer; Akiz, CenkBACKGROUND: Infection follow-up in patients stabilized with the Dynesys system. Infection rates were determined in patients who had >= 5 segments stabilized with the Dynesys system. METHODS: Eighty-three patients with various etiologies were stabilized with the Dynesys system. Long-level stabilization patients were separated from the main group as a result of their high rates of infection. RESULTS: Long-level stabilizations were performed in 8 of 83 patients. Five patients were determined to have infections including 4 deep infections and 1 superficial infection. In patients with deep infections, 3 of them exhibited chronic infections that lasted for approximately 2 years and the system was removed. A deep infection in 1 patient and a superficial infection in 1 patient were diagnosed after 1 month. The early-diagnosed deep infection patient was treated with wound irrigation and antibiotics. The system was not removed, and the wound was closed with daily dressing after 45 days. One superficial infection patient was only treated with daily dressing, and the infection healed within 2 weeks. The infectious agent was determined in 2 patients. Three patients in the chronic infection group underwent a surgical procedure to remove the system. Specific antibiotic treatments were administered to patients whose infectious agents were identified. The remaining patients were treated with wide-spectrum antibiotics. CONCLUSIONS: We report that long-level stabilization with the Dynesys system results in a high infection rate.Öğe Infected colloid cyst(Springer, 2017) Yilmaz, Atilla; Aras, Mustafa; Serarslan, Yurdal; Kaya, Mustafa EmrahIntroduction Colloid cysts are the most common pathologic lesions of the third ventricle. Although they are histologically benign, they may grow and can cause the hydrocephalus. Case summary A 5-year-old male patient underwent to surgery with the diagnosis of colloid cyst. In operation, after the anterior transcallosal approach, the cyst was punctured by syringe and obviously pus aspirated. Conclusion Colloid cysts mostly remain silent and detected incidentally. Although it is rarely defined, rhinorrhea, hypopituitarism, diabetes insipidus, spasmodic torticollis, drop attack, aseptic meningitis, and coexistence with neurocysticercosis have been reported, but this is the first reported case of an infected colloid cyst.Öğe Investigating the effect of STN-DBS stimulation and different frequency settings on the acoustic-articulatory features of vowels(Springer-Verlag Italia Srl, 2018) Yilmaz, Atilla; Sarac, Elif Tugba; Aydinli, Fatma Esen; Yildizgoren, Mustafa Turgut; Okuyucu, Emine Esra; Serarslan, YurdalIntroduction Parkinson's disease (PD) is the second most frequent progressive neuro-degenerative disorder. In addition to motor symptoms, nonmotor symptoms and voice and speech disorders can also develop in 90% of PD patients. The aim of our study was to investigate the effects of DBS and different DBS frequencies on speech acoustics of vowels in PD patients. Methods The study included 16 patients who underwent STN-DBS surgery due to PD. The voice recordings for the vowels including [a], [e], [i], and [o] were performed at frequencies including 230, 130, 90, and 60 Hz and off-stimulation. The voice recordings were gathered and evaluated by the Praat software, and the effects on the first (F1), second (F2), and third formant (F3) frequencies were analyzed. Results A significant difference was found for the F1 value of the vowel [a] at 130 Hz compared to off-stimulation. However, no significant difference was found between the three formant frequencies with regard to the stimulation frequencies and off-stimulation. In addition, though not statistically significant, stimulation at 60 and 230 Hz led to several differences in the formant frequencies of other three vowels. Conclusion Our results indicated that STN-DBS stimulation at 130 Hz had a significant positive effect on articulation of [a] compared to off-stimulation. Although there is not any statistical significant stimulation at 60 and 230 Hz may also have an effect on the articulation of [e], [i], and [o] but this effect needs to be investigated in future studies with higher numbers of participants.Öğe Investigating the effects of subthalamic Nucleus-Deep brain stimulation on the voice quality(Taylor & Francis Ltd, 2020) Sarac, Elif Tugba; Yilmaz, Atilla; Aydinli, Fatma Esen; Yildizgoren, Mustafa Turgut; Okuyucu, Emine Esra; Okuyucua, Semsettin; Akakin, AkinIntroduction: Deep brain stimulation (DBS) is a standard surgical treatment method which is generally applied to subthalamic nucleus in Parkinson's patients in cases where medical treatment is insufficient in treating the motor symptoms. It is known that Subthalamic Nucleus Deep Brain Stimulation (STN-DBS) treats many motor symptoms. However, the results of studies on speech and voice vary. The aim of the study is analysing the effect of STN-DBS on the characteristics of voice. Materials/methods: A total of 12 patients, (8 male-4 female) with an age average of 58.8 +/- 9.6, who have been applied DBS surgery on STN included in the study. The voice recordings of the patients have been done prior to surgery and 6 months after the surgery. The evaluation of voice has been carried out through the instrumental method. The patients' voice recordings of the /a,e,i/ vowels have been done. The obtained recordings were evaluated by the Praat programme and the effects on jhitter, shimmer, fundamental frequency (F0) and noise harmonic rate (NHR) were analysed. Results: Numerical values of F0 of all female participants have been decreased for all of the vowels postoperatively. In the females; jhitter and fraction parameters were found to be significantly different (0.056 and 0.017, perspectively) for the vowel /e/. In addition, p values in the shimmer for vowels /e,i/ were thought to be clinically significant (.087, .079 and .076) respectively. All these changes in second measurements were found to indicate worsening vocal quality after the DBS in females. In males, there is not any significant difference observed between two measures in any of the parameters of any vowels. Conclusions: Acoustic voice quality deteriorated after STN-DBS predominantly for females however this deterioration was not prominent audio-perceptually. This finding commented as a result of the fact that that voice quality deviance of the participants was not severe.Öğe Lumbar Single-Level Dynamic Stabilization with Semi-Rigid and Full Dynamic Systems: A Retrospective Clinical and Radiological Analysis of 71 Patients(Korean Orthopaedic Assoc, 2017) Ozer, Ali Fahir; Oktenoglu, Tunc; Egemen, Emrah; Sasani, Mehdi; Yilmaz, Atilla; Erbulut, Deniz Ufuk; Yaman, OnurBackground: This study compares the clinical and radiological results of three most commonly used dynamic stabilization systems in the field of orthopedic surgery. Methods: A total of 71 patients underwent single-level posterior transpedicular dynamic stabilization between 2011 and 2014 due to lumbar degenerative disc disease. Three different dynamic systems used include: (1) the Dynesys system; (2) a dynamic screw with a PEEK rod; and (3) a full dynamic system (a dynamic screw with a dynamic rod; BalanC). The mean patient age was 45.8 years. The mean follow-up was 29.7 months. Clinical and radiological data were obtained for each patient preoperatively and at 6, 12, and 24 months of follow-up. Results: Clinical outcomes were significantly improved in all patients. There were no significant differences in the radiological outcomes among the groups divided according to the system used. Screw loosening was detected in 2 patients, and 1 patient developed screw breakage. All patients with screw loosening or breakage underwent revision surgery. Conclusions: Each procedure offered satisfactory outcome regardless of which system was applied.Öğe Percutaneous Kyphoplasty Is Bilateral Approach Necessary?(Lippincott Williams & Wilkins, 2018) Yilmaz, Atilla; Cakir, Murteza; Yucetas, Cem Seyho; Urfali, Boran; Ucler, Necati; Altas, Murat; Aras, MustafaStudy Design. A multicenter retrospective study of patients who underwent unilateral and bilateral balloon kyphoplasty. Objective. The aim of this study was to compare the radiographic and clinical results of unilateral and bilateral balloon kyphoplasty to treat osteoporotic vertebral compression fractures. Summary of Background Data. Percutaneous kyphoplasty has long been used as a successful method in the treatment of osteoporotic vertebral compression fractures. Although the bilateral approach is considered to be the mainstay application of percutaneous kyphoplasty, the unilateral approach has also been shown to be sufficient and even more effective in some cases. Methods. A total of 87 patients who underwent percutaneous kyphoplasty due to osteoporotic vertebral compression fractures between 2009 and 2016 were retrospectively evaluated and divided into two groups as patients who underwent unilateral or bilateral percutaneous kyphoplasty. Unilateral percutaneous kyphoplasty was performed in 36 and bilateral percutaneous kyphoplasty in 51 patients. The groups were compared in terms of clinical outcomes, radiological findings, and complications. Clinical outcomes were evaluated using Visual Analogue Scale and Oswestry Disability Index and the radiological findings were evaluated by comparing the preoperative and postoperative day 1 and year 1 values of anterior, middle, and posterior vertebral heights and kyphosis angle. Results. Clinical improvement occurred in both groups but no significant difference was observed. In radiological workup, no significant difference was found between the groups in terms of improvements in vertebral heights and kyphosis angle. Operative time and the amount of cement used for the surgery were significantly lower in the patients that underwent unilateral kyphoplasty. Conclusion. Unilateral percutaneous kyphoplasty is as effective as bilateral percutaneous kyphoplasty both radiologically and clinically. Operative time and the amount of cement used for the surgery are significantly lower in unilateral kyphoplasty, which may play a role in decreasing complication rates.Öğe Protective effects of minocycline on experimental spinal cord injury in rats(Elsevier Sci Ltd, 2015) Aras, Mustafa; Altas, Murat; Motor, Sedat; Dokuyucu, Recep; Yilmaz, Atilla; Ozgiray, Erkin; Seraslan, YurdalBackground: The effects of minocycline on neuronal injury after spinal cord injury (SCI) are limited and controversial. Therefore we aimed to investigate the protective effects of minocycline on tissue and on serum concentrations of malondialdehyde (MDA) levels, superoxide dismutase (SOD) activity, glutathione peroxidase (GSH-Px) activity, tissue total antioxidant and oxidant status (TAS and TOS, respectively), and AST and LDH levels in rats with SCI. Methods: This study was performed on 7-8 weeks 38 male Wistar albino rats. The animals were randomly divided into five groups: group 1, Sham (n = 8); group 2, SCI (spinal cord injury)/control (n = 8); group 3, SCI + minocycline3 (n = 7); group 4, SCI + minocycline30 (n = 8) and group 5 SCI + minocycline90 (n = 7). Blood and tissue samples were analysed for MDA, SOD, GSH-Px, TAS, TOS, AST and LDH levels. Results: The MDA levels were significantly higher in SCI group compared to sham group (p < 0.001), and MDA levels were also significantly higher in SCI group compared to SCI + M-3, SCI + M-30, SCI + M-90 (p < 0.05). SOD levels were significantly higher in SCI + M-30 when compared to SCI and SCI + M-3 groups (p < 0.05). GSH-Px levels decreased significantly in SCI and SCI + M-3 groups compared to sham (p < 0.05). SCI + M-3 group showed significantly decreased levels of TAS and TOS compared to SCI group (p < 0.05). TAS and TOS levels significantly increased in SCI + M-90 group compared to SCI + M-3 and SCI + M-30 groups (p < 0.05). Conclusions: The present study demonstrates the dose-dependent antioxidant activity of minocycline against spinal cord injury in rats. Minocycline administration increased antioxidant enzyme levels and improved total antioxidant status. (C) 2015 Elsevier Ltd. All rights reserved.Öğe Protrusion of a peritoneal catheter via abdominal wall and operated myelomeningocele area: a rare complication of ventriculoperitoneal shunt(Springer, 2013) Aras, Mustafa; Altas, Murat; Serarslan, Yurdal; Akcora, Buelent; Yilmaz, AtillaVentriculoperitoneal shunting is mostly used in the treatment of hydrocephalus, and many complications have been reported with this method. These complications include obstruction, mechanical shunt failure, infection, and abdominal complications. Abdominal complications include intestinal obstruction, volvulus, peritonitis, peritoneal cyst, cerebrospinal fluid ascites, as well as migration of the distal catheter via the intestinal tract, umbilicus, scrotum, and vagina. Various mechanisms have been suggested with regards to the catheter migration. We present a case of a 21-month-old female patient who had myelomeningocele at birth. She underwent repair of the myelomeningocele at the age of 10 days. After 4 months, cranial computed tomography revealed hydrocephalus, and ventriculoperitoneal shunt was placed. Because of shunt dysfunction, a new ventriculoperitoneal shunt system was installed at the age of 12 months. Eight months later, her mother noticed the protrusion of peritoneal catheter via abdominal wall and repaired myelomeningocele area. Revision of the lower end of the shunt was done, and myelomeningocele area was repaired again. We report a unique patient with the protrusion of the distal catheter through repaired myelomeningocele area and abdominal wall in the lumbar region.Öğe A rare complication of subdural-peritoneal shunt: Migration of catheter components through the pelvic inlet into the subdural space(Medknow Publications & Media Pvt Ltd, 2017) Cakir, Murteza; Yilmaz, Atilla; Calikoglu, CagataySubdural-peritoneal (SP) shunting is a simple procedure to treat subdural hygromas; however, several rare complications such as shunt migration exist. A 15-year-old boy presented with headache, nausea, and vomiting , and underwent SP shunting for left frontoparietal chronic subdural effusion. Six weeks later, radiographic examinations revealed total migration of the shunt through the pelvic inlet. The migrated shunt was replaced with a new SP shunt. Four weeks later, radiographic examinations revealed shunt migration into the subdural space. The shunt catheter was removed and the subdural effusion was evacuated. Shunt migration may result from pressure differences between the abdomen and the cranium or from head movement, and insufficient fixation and/or large burr holes can facilitate shunt migration. Double firm anchoring and small-sized burr holes can prevent this complication. SP shunt is a simple procedure, and its assumed complications can be prevented through precaution.Öğe Serum nesfatin-1 levels: a potential new biomarker in patients with subarachnoid hemorrhage(Taylor & Francis Ltd, 2017) Cakir, Murteza; Calikoglu, Cagatay; Yilmaz, Atilla; Akpinar, Erol; Bayraktutan, Zafer; Topcu, AtillaBackground: Acute subarachnoid hemorrhage (SAH) is a neurological emergency with significant potential for long-term morbidity and mortality. Nesfatin-1 is a polypeptide which is found in various regions of the brain that play role in the feeding and metabolic regulation. Objective: So this study aimed to investigate if nesfatin-1 levels in patients with SAH, could be used as a marker for the severity and prognosis. Method: Forty-eight consecutive patients (except those excluded) admitted to the emergency service of our hospital and hospitalized at our clinic with the diagnosis of aneurysmal SAH between 2011 and 2013 were included in the study and followed up for six months for outcome. The control group consisted of 48 healthy individuals of similar age and gender. Results: During the 6-month follow-up, 7 of 48 patients died and 16 (33.3%) patients had poor Glasgow Outcome Score (GOS) scores. In the study group, themean nesfatin-1 level was significantly higher than the control group (7.36 +/- 2.5 pg/ml and 4.29 +/- 2.02 pg/ml, respectively; p < 0.01). The mean nesfatin-1 level was 11.58 +/- 0.87 pg/ml in the non-survival group and 6.64 +/- 1.89 pg/ml in the survival group. Furthermore, it was 10.22 +/- 1.42 pg/ml in patients with poor outcome in terms of GOS and 5.93 +/- 1.46 pg/ml in those with good outcome. The nesfatin-1 levels significantly increased with worsening of GOS, the World Federation of Neurological Surgeons grading system, and Fisher scores and increasing plasma C-reactive protein levels (p < 0.01 for all). Conclusion: The present study is the first that shows the mortality/poor outcome of the SAH with assessing serum nesfatin-1 levels. So levels of nesfatin-1 might be useful in SAH management.Öğe Suspension of the spinal dura mater to the corpectomy cage with tack-up sutures for bleeding control and prevention of epidural hematoma: Operative technique(Warmia and Mazury Medical Chamber, 2018) Çakır, Mürteza; Yilmaz, Atilla; Kadıoğlu, Hakan H.; Çalıkoğlu, ÇağatayIntroduction: Postoperative spinal epidural hematoma (PSEH) is a rare complication of spinal surgery that requires surgery in very few patients. Unless prompt diagnosis and intervention is performed, neurologic deficits and mortality may occur depending on the localization of the PSEH. Aim: In this report, we present a case that underwent tack-up suture technique with the suspension of the spinal dura mater to the corpectomy cage for bleeding control and prevention of epidural hematoma. Case study: A 70-year-old male patient was admitted with paresis on the right arm. MRI showed protrusion and grade 2 spondylolisthesis at C3–C4, obliteration of anterior cerebrospinal fluid column caused by osteophytes at C4–C5–C6, and loss of intervertebral disc height and degenerative fusion at the same level. C4–C5 anterior corpectomy and instrumentation was performed. Two hours after surgery, neurologic deficits developed and an epidural hematoma was detected on MRI. The patient underwent a revision surgery and hemostasis was achieved by the suspension technique. Neurologic deficits recovered postoperatively. Postoperative MRI showed the suspension of dura like a tent and no hematoma in the epidural space. Results and discussion: Prevention of PSEH in addition to prompt diagnosis and surgical intervention is highly important for the prevention of adverse outcomes. In our case, we achieved successful hemostasis by suspending the dura to implanted instrument in the paravertebral region. Conclusions: Suspension of the dura with tack-up sutures can be a useful technique for the prevention of PSEH and risk of cord compression. © 2018 Warmia and Mazury Medical Chamber. All rights reserved.Öğe Use of programmable versus nonprogrammable shunts in the management of normal pressure hydrocephalus A multicenter retrospective study with cost-benefit analysis in Turkey(Lippincott Williams & Wilkins, 2017) Serarslan, Yurdal; Yilmaz, Atilla; Cakir, Murteza; Guzel, Ebru; Akakin, Akin; Guzel, Asian; Urfali, BoranVentriculoperitoneal shunt systems that are used in the treatment of normal pressure hydrocephalus are often associated with drainage problems. Adjustable shunt systems can prevent or treat these problems, but they may be expensive. The aim of our study is to compare the complications and total cost of several shunt systems. Patients with normal pressure hydrocephalus who underwent ventriculoperitoneal shunting between 2011 and 2016 were included in the study. The study involves patient consent and the informed consent was given. Complications and the average cost per person were compared between patients with adjustable and nonadjustable shunts. Shunt prices, surgical complications, and revision costs were taken into account to calculate the average cost. Of the 110 patients who were evaluated, 80 had a nonadjustable shunt and 30 had an adjustable shunt. In the group with adjustable shunts, the rates of subdural effusion and hematoma were 19.73% and 3.29%, respectively. In the group with nonadjustable shunts, these rates were 22.75% and 13.75%, respectively. One patient in the adjustable group underwent surgery for subdural hematoma, while 8 patients in the nonadjustable group underwent the same surgery. Ten patients required surgical intervention for subdural effusion and existing shunt systems in these patients were replaced by an adjustable shunt system. When these additional costs were factored into the analysis, the difference in cost between the shunt systems was reduced from 600 United States dollars (USD) to 111 USD. When the complications and additional costs that arise during surgical treatment of normal pressure hydrocephalus were considered, the price difference between adjustable and nonadjustable shunt systems was estimated to be much lower.Öğe A Very Rare Complication of Cerebral Hydatid Cyst Surgery: Cortical Collapse(Medknow Publications & Media Pvt Ltd, 2017) Cakir, Murteza; Calikoglu, Cagatay; Yilmaz, AtillaHydatid diseases are still endemic pathologies in developing countries which generally needs surgical treatment. The main aim of the treatment is total cyst evacuation without rupture. Dowling technique is preferable for this aim. There are various complications of hydatid disease surgery which include cortical collapse which is very serious and can be mortal. Our case was a 6-year-old boy diagnosed with a solitary isointense cystic mass in the left parietal region. There was no surrounding edema. The cyst was completely evacuated with Dowling technique without rupture. In about 10 min after evacuation, hemispheric cortical collapse occurred, and the patient developed cardiac arrest. Although cortical collapse is a rare complication, it can cause perioperative mortality. Special care and efforts should be taken as not to form large defects after cyst evacuation to prevent cortical collapse and related mortality.
