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Öğe Application of syringosubarachnoid shunt through key-hole laminectomy Technical note(2000) Gezen, Ferruh; Kahraman, Serdar; Ziyal, İbrahim Mustafa; Çanakçı, Zafer; Bakır, AbdurrahmanThe authors describe the key-hole laminectomy technique (KHLT) for application of syringosubarachnoid shunts. This technique was used in 29 patients with noncommunicating syringomyelia. In all cases the shunts were inserted successfully without any peri- or late postoperative complications. The late follow-up magnetic resonance examinations revealed the clear collapse of syrinx in all cases. The authors advocate use of the KHLT because it is associated with less surgery-related trauma, epidural fibrosis, infection, and spinal instability.Öğe Brucellar lumbar epidural abscess - case report and review(Lippincott Williams & Wilkins, 2006) İş, Merih; Gezen, FerruhBrucellosis is an infectious disease characterized by an acute febrile stage with few or no localizing signs and a chronic stage with relapses of fever, weakness, sweats, and vague symptoms. Brucellosis is one of the major causes of spondylitis in the Mediterranean area. We present a 46-year-old woman who had pain in the low back and both legs for 2 months. The diagnosis was performed on clinical presentation, laboratory findings (Rose Bengal and Wright agglutination tests), and magnetic resonance imaging. Magnetic resonance imaging revealed an extradural mass compressing the thecal sac at the L5-S1 level. The mass was isointense to hypointense compared with the spinal cord on T1WI and heterogenic hyperintense on T2WI. With contrast material, heterogeneous enhancement was seen. The patient was treated with surgery and 3 antibiotics. In an endemic area, brucellosis should be included in the differential diagnosis of any patient complaining of back or leg pain.Öğe Calvarial metastasis of a paraganglioma - case report and review of the literature(Elsevier Science Inc, 2000) Gezen, Ferruh; Ziyal, İbrahim M.; Baysefer, Alper; Kahraman, Serdar; Çıklatekerlioğlu, ÖzcanBACKGROUND Metastasis of a paraganglioma (PRG) to the calvarium is very rare. In this paper, the case of a 25-year-old male with metastasis of a PRG to the frontoparietal bone is described. CASE DESCRIPTION The patient presented with bulging on the left side of the head, headache, and weight loss. Magnetic resonance imaging (MRI) revealed a mass lesion in the left frontoparietal region that had destroyed both the external and internal table of the bone, extending under the skin and above the dura mater. After a frontoparietal craniotomy the tumor was removed totally. Histopathological examination revealed the "Zellballen," which are pathognomonic for a PRG. Systemic examination and radiological investigation revealed no primary tumor source. CONCLUSION Metastasis of a PRG to the calvarium is possible; radical removal of the tumor will provide a cure.Öğe Çocukluk ve erişkin dönemi "Büyüyen kafa kırıkları" (sessiz bir komplikasyondan komplike patolojik süreçe uzanan yol)(2000) Ziyal, İbrahim M.; Döşoğlu, Murat; İş, Merih; Yıldız, Hakan; Yücel, Engin; Gezen, FerruhBüyüyen Kafa Kırıkları (BKK) çocukluk dönemi kafa travmalarının nadir bir komplikasyonudur. Erişkin döneminde tanı konan olgular daha da nadirdir ve başlıca neden yeterli tedavinin uygulanmamış olması ya da gecikmiş tanıdır. Bu çalışmada, beşi erişkin döneminde olmak üzere onbeş BKK olgusu sunulmaktadır. On olguda leptomeningeal kist ile birlikte ya da olmaksızın kafa kırığında genişleme tesbit edildi. Bu gruptaki (Grup I) olguların 7si erkek, üçü bayan ve olguların ortalama yaşı 14.9 ay idi. Yırtılmış olan duraya bağlı olarak kırık kemik kenarları birbirinden ayrılmış ve beyin omurilik sıvısı ile dolu araknoid boşluk bir leptomeningeal kiste dönüşmüş idi. Dokuz olgu kafada şişlik ve şekil bozukluğu, bir olgu ise nöbet şikayeti ile başvurdu. Tanı konmamış ya da tanı konmakta gecikilmiş olgularda kist genişlemekte, ensefalomalazi ve parankim dokusu kaybı oluşmakta ve kist ventrikül ile birleşmektedir. Böylece bir porensefalik kist ortaya çıkmaktadır. Erişkin döneminde tanı konan beş olgumuz ise bu patolojik ilerlemeyi göstermekte idi (Grup II). Bu olguların 4ü erkek, biri bayan ve ortalama yaşları 14.6yıl idi. Sadece nöbet dört olguda, sol hemiparezi ile birlikte nöbet ise bir olguda tesbit edildi. Grup l olgular kranyotomi ve duraplasti ile tedavi edildiler. Kemik büyümesi tamamlandıktan sonra iki olguya kranyoplasti uygulandı. Grup II olgular kranyotomi, duraplasti ve kranyoplasti ile tedavi edildiler. Bu grubun iki olgusu daha sonra şant uygulamasını gerektirdi. Olguların tedavi sonrası ortalama takip süresi 37 ay olarak tesbit edildi. Erişkin olgularda tedavi sonuçları yetersiz kaldı ve beş olgudan sadece birinde nöbetler önlenebildi. Sonuç olarak, BKKda erken tanı, uygun tedavinin seçimi, yeterli iyileşme ve geç başarısız sonuçların önlenmesi için kafa travması sonrası oluşan lineer kırıkların en az iki sene düzgün aralıklar ile takibi esas olmalıdır.Öğe Çocukluk ve erişkin dönemi "Büyüyen kafa kırıkları"(Sessiz bir komplikasyondan komplike patolojik süreçe uzanan yol)(2000) Ziyal, Ibrahim M.; Döşoğlu, Murat; Iş, Merih; Yildiz, Hakan; Yücel, Engin; Gezen, FerruhBüyüyen Kafa Kırıkları (BKK) çocukluk dönemi kafa travmalarının nadir bir komplikasyonudur. Erişkin döneminde tanı konan olgular daha da nadirdir ve başlıca neden yeterli tedavinin uygulanmamış olması ya da gecikmiş tanıdır. Bu çalışmada, beşi erişkin döneminde olmak üzere onbeş BKK olgusu sunulmaktadır. On olguda leptomeningeal kist ile birlikte ya da olmaksızın kafa kırığında genişleme tesbit edildi. Bu gruptaki (Grup I) olguların 7si erkek, üçü bayan ve olguların ortalama yaşı 14.9 ay idi. Yırtılmış olan duraya bağlı olarak kırık kemik kenarları birbirinden ayrılmış ve beyin omurilik sıvısı ile dolu araknoid boşluk bir leptomeningeal kiste dönüşmüş idi. Dokuz olgu kafada şişlik ve şekil bozukluğu, bir olgu ise nöbet şikayeti ile başvurdu. Tanı konmamış ya da tanı konmakta gecikilmiş olgularda kist genişlemekte, ensefalomalazi ve parankim dokusu kaybı oluşmakta ve kist ventrikül ile birleşmektedir. Böylece bir porensefalik kist ortaya çıkmaktadır. Erişkin döneminde tanı konan beş olgumuz ise bu patolojik ilerlemeyi göstermekte idi (Grup II). Bu olguların 4ü erkek, biri bayan ve ortalama yaşları 14.6yıl idi. Sadece nöbet dört olguda, sol hemiparezi ile birlikte nöbet ise bir olguda tesbit edildi. Grup l olgular kranyotomi ve duraplasti ile tedavi edildiler. Kemik büyümesi tamamlandıktan sonra iki olguya kranyoplasti uygulandı. Grup II olgular kranyotomi, duraplasti ve kranyoplasti ile tedavi edildiler. Bu grubun iki olgusu daha sonra şant uygulamasını gerektirdi. Olguların tedavi sonrası ortalama takip süresi 37 ay olarak tesbit edildi. Erişkin olgularda tedavi sonuçları yetersiz kaldı ve beş olgudan sadece birinde nöbetler önlenebildi. Sonuç olarak, BKKda erken tanı, uygun tedavinin seçimi, yeterli iyileşme ve geç başarısız sonuçların önlenmesi için kafa travması sonrası oluşan lineer kırıkların en az iki sene düzgün aralıklar ile takibi esas olmalıdır.Öğe Epidural extension of a lumbar vertebral haemangioma(Elsevier Sci Ltd, 2006) İş, Merih; Gezen, Ferruh; Alper, Murat; Yıldız, Hakan Kartal; Akyüz, FevzullahVertebral haemangiomas are relatively common, but those extending into the epidural space are rare. A 59-year-old man with severe lower back and right leg pain that did not resolve with conservative treatment was seen in an outpatient clinic. Magnetic resonance imaging of the lumbar spine identified an L3 vertebral corpus lesion with epidural extension. The diagnosis was unclear, so the patient underwent surgery. The pathologic diagnosis was capillary haemangioma, so angiography-guided embolization was performed postoperatively. Vertebral haemangioma must be considered when there is evidence of a vertebral corpus lesion with epidural extension on magnetic resonance imaging.Öğe Erken spontan rezolüsyona uğrayan Subdural Hematom: Olgu sunumu(2012) Çalıkoğlu, Çağatay; Aykanat, Ömer; Akgül, Mehmet Hüseyin; Gezen, FerruhSağ temporoparietal travmatik akut subdural hematom (ASDH) nedeni ile başvuran ve 3 saat içinde klinik tabloda düzelme ile birlikte bilgisayarlı beyin tomografi tetkikinde hematomu tamamen rezolüsyona uğrayan 29 yaşında erkek hasta olgusu sunuldu. Olgumuz literatürdeki erken (3 saat 15 dakika) spontan rezolüsyona uğrayan ASDH olgusularından birisidir.Öğe High-sensitivity C-reactive protein levels in cerebrospinal fluid and serum in severe head injury: relationship to tumor necrosis factor-alpha and interleukin-6(Churchill Livingstone, 2007) İş, Merih; Coşkun, Abdurrahman; Sanus, Galip Zihni; Tanrıverdi, Taner; Kafadar, Ali Metin; Hanımoğlu, Hakan; Gezen, FerruhRecent studies have demonstrated the role of high-sensitivity C-reactive protein (hsCRP) in inflammatory diseases; however, it is unclear whether this molecule has a role after severe head injury (SHI). Our aim was to evaluate the levels of hsCRP in both cerebrospinal fluid (CSF) and serum from patients after SHI. The study focused on 11 patients with SHI and evaluated CSF and serum levels of hsCRP, tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) in a 10-day period following the head trauma. The values were compared with those from nine control patients, who had normal pressure hydrocephalus. In the CSF and serum of the patients after SHI HsCRP was found to be significantly higher, at all times, than in the controls; TNF-alpha and IL-6 levels were also higher in these patients. However, hsCRP levels did not correlate with either TNF-alpha or IL-6. TNF-alpha and IL-6 increased during the period immediately following the SHI and intrathecal levels were always higher than those of the serum. This study demonstrates for the first time that hsCRP reaches high levels in both CSF and serum in patients with SHI, and it may therefore be used as an inflammatory index. This finding suggests a need for further studies in this area, which are larger in scope than the present study.Öğe Opere edilmeyen dev serebellar hematom: Olgu sunumu(2005) Gezen, Ferruh; İş, Merih; Yıldız, Hakan K.; Döşoğlu, Murat; Tuncer, CengizSpontan intraserebellar hematomlu (SİH) hastaların tedavisi halen tartışmalıdır. Bilgisayarlı tomografi (BT) SİH'un erken ve doğru tanısını sağlar, SİH'un boyut ve lokalizasyonu kesin bir şekilde tanımlanabilir. Sonucu etkileyen temel prognostik faktörler hastanın başvuru sırasındaki klinik durumu, hematomun boyut ve lokalizasyonu, beyin sapı basısı, intraventriküler kanama ve hidrosefali varlığıdır. Bu çalışmada altmış iki yaşında tıbbi tedavi yapılan dev serebellar hematomlu bayan hasta sunulmuştur.Öğe Posterior epidural migration of a lumbar disc fragment causing cauda equina syndrome: case report and review of the relevant literature(Springer-Verlag, 2001) Döşoğlu, Murat; İs, Merih; Gezen, Ferruh; Ziyal, İbrahim M.Posterior epidural migration (PEM) of free disc fragments is rare, and reported PEM patients usually presented with radicular signs. An uncommon case involving a patient with cauda equina syndrome due to PEM of a lumbar disc fragment is reported with a review of the literature. The patient described in this report presented with an acute cauda equina syndrome resulting from disc fragment migration at the L3-L4 level that occurred after traction therapy for his lower back pain. The radiological characteristics of the disc fragment were the posterior epidural location and the ring enhancement. A fenestration was performed and histologically confirmed sequestered disc material was removed. An early postoperative examination revealed that motor, sensory, urological, and sexual functions had been recovered. At late followup, the patient was doing well after 18 months. Sequestered disc fragments may occasionally migrate to the posterior epidural space of the dural sac. Definite diagnosis of posteriorly located disc fragments is difficult because the radiological images of disc fragments may mimic those of other more common posterior epidural lesions.Öğe Regional anatomic structures of the elbow that may potentially compress the ulnar nerve(Mosby-Elsevier, 2009) Karatas, Ayse; Apaydin, Nihal; Uz, Aysun; Tubbs, Shane R.; Loukas, Marios; Gezen, FerruhHypothesis: Traumatic injuries to the ulnar nerve at the elbow are a frequent problem as it is vulnerable to stretching and compression with motion of the upper limb. The aim of the present study was to explore the course of the ulnar nerve at the elbow and forearm and to determine possible anatomical structures that may cause compression of this structure. Materials and methods: We examined 12 upper limbs from cadavers. The length of any fibrous bands, and if present, their distance to the medial epicondyle was recorded. Results: On 5 sides a fibrous band originating from the medial intermuscular septum was observed to cross over the ulnar nerve. The average length of the fibrous band was 5.7 cm, and it attached to the medial epicondyle. The mean length of the ulnar nerve as it coursed in the cubital tunnel was 3.8 cm. In 4 of the cases, the ulnar nerve was covered by muscle fibers originating from the flexor digitorum superficialis and extending to the flexor carpi ulnaris. On 5 sides we observed fibrous thickenings, and on 8 sides vascular structures were found crossing over the ulnar nerve. Discussion: The cubital tunnel is the most common site of compression of the ulnar nerve. Numerous surgical procedures are recommended for cubital tunnel syndrome. Simple decompression is used most commonly. Although surgical procedures are reported to provide efficient pain relief and functional recovery, residual or recurrent symptoms have been reported. Reasons for such recurrences may be more proximal or distal compression of the ulnar nerve as seen in our study. Conclusion: Knowledge of possible compression sites of the ulnar nerve is important to the surgeon so that complications are avoided and postoperative recurrence is decreased. Level of evidence: Basic science study. (C) 2009 Journal of Shoulder and Elbow Surgery Board of Trustees.Öğe Review of 36 cases of spinal cord meningioma(Lippincott Williams & Wilkins, 2000) Gezen, Ferruh; Kahraman, Serdar; Çanakçı, Zafer; Bedük, AltayStudy Design. Thirty-six consecutive patients with histologically confirmed spinal cord meningioma were presented to evaluate clinical, diagnostic, therapeutic options and to correlate treatment methods and outcome. Objective. To present the incidence, clinical presentation, localization, techniques, and long term results of surgically treated spinal meningiomas. Summary of Background Data. Meningiomas are common tumors of spinal neoplasm. They are generally benign and slow-growing. Advanced in radiologic and surgical techniques have brought about better surgical results. The goal of surgical treatment must be total resection if possible. However, spinal meningiomas may recur, especially as a result of incomplete resection. Methods. Thirty-six consecutive patients with histologically confirmed spinal meningiomas were treated from 1980 to 1997. Neuroradiological diagnosis was made through myelogram in 20 patients, CT scan in 15 patients, and MRI in 16 patients. All patients were operated on via the posterior approach and using microsurgical technique and when necessary Cooper-Ultrasonic surgical aspirator (CUSA) and CO2 laser were also applied. The patients were followed for 2 to 15 years (mean 9 years). Radiotherapy was not undertaken except in recurrent tumors. Results. The most frequent site of spinal meningiomas was in the thoracic region. In 30 (83%) patients tumors were found to be completely intradural extramedullary during surgery. Total tumor resection was achieved in 35 (97%) of patients. In the follow-up period, 30 cases (83%) improved when compared to their preoperative conditions. There was one operative mortality (3%). A 66-year-old women died of pulmonary emboli. Conclusions. Magnetic resonance imaging is the best imaging technique for diagnosis. Total tumor resection improved the surgical results of spinal meningiomas. If total removal of the tumor cannot be achieved, or in the case of early recurrence followed by total resection, radiotherapy should be performed in adjuvant therapy.Öğe Unoperated giant cerebellar hematoma: Case report(Aves, 2005) Gezen, Ferruh; Is, Merih; Yildiz, K. Hakan; Dosoglu, Murat; Tuncer, CengizThe treatment of patients with spontaneous intracerebellar hematoma (SIH) still remains controversial. Computerized tomography (CT) offers early and accurate diagnosis of SIH, the size and location of SIH can be precisely defined. The main prognostic factors affecting the outcome are the clinical state of the patient on admission, the size and localization of the hematoma, compression of brain-stem, and the presence of intraventricular hematoma and hydrocephalus. In this report, a 62 year old female patient with a giant cerebellar hematoma who was treated medically was presented.Öğe The use of methylprednisolone, vitamin E and their combination in acute spinal cord injury: An experimental study(Turkish Neurosurgical Society, 2006) İş, Merih; Ulu, Mustafa Onur; Tanriverdi, Taner; Yıldız, Hakan; Akyüz, Fevzullah; Aksoy, Aylin; Gezen, FerruhObjective: The effects of methyprednisolone (MP) and Vitamin E (Vit E) combination treatment was investigated in an experimental spinal cord injury model in rats. Method: Thirty-one rats were randomly divided into the five following groups: control group, MP group, Vit E group, MP+Vit E group and sham operated group. A spinal cord injury was produced in the rats by using a compression injury model at the T8 vertebra level for 10 minutes. MP was injected as a 30 mg/kg IV bolus, 1 hour after the injury, followed by an infusion of 5.4mg/kg for 23 hours. Vit E was administered as a 30 mg/kg IV bolus at the posttraumatic 1st, 7th, 13th and 19th hours. The sham group underwent laminectomy without spinal cord compression and did not receive medication. The animals were sacrificed at the posttraumatic 48th hour and histopathological examination was performed in a blinded fashion for the following criteria: hemorrhage, necrosis, edema, microcyst, microglia proliferation and PMNL infiltration. Results: The pathology evaluation of the groups revealed that the MP+Vit E combination treatment impeded the progress of edema/microcyst formation, microglia proliferation, and necrosis. Conclusion: Vit E, when combined with MP for spinal cord injury treatment, augments the effect of MP probably due to its antioxidant effects.Öğe Yings and yangs of acute ethanol intoxication in experimental traumatic brain injury(Lippincott Williams & Wilkins, 2005) İş, Merih; Tanrıverdi, Taner; Akyüz, Fevzullah; Ulu, Mustafa Onur; Üstündağ, Nil; Gezen, Ferruh; Yavuz, ÖzlemAlthough the deleterious effects of acute alcohol intoxication on traumatic brain injury (TBI) are well known, neuroprotective features of lower doses of ethanol (EtOH) before head trauma have been reported during recent years. Inhibition of N-methyl-D-aspartate receptor (NMDA)-mediated excitotoxicity by lower doses of EtOH has been believed to be responsible for this protection. The aim of this study was to show the neuroprotective effects of low and moderate doses of EtOH and to compare their efficacy in each group. Acute EtOH intoxication at low and moderate doses was induced 40 minutes before trauma. Severe TBI was administered in Sprague-Dawley rats using an impact acceleration model. At 24 hours after trauma, all the rats were decapitated and hippocampi were evaluated under light microscopy. According to our results, red neuron formation and vacuolar degeneration in the CA1 and CA3 sectors of the hippocampi were less prominent in the lowdose and moderate-dose EtOH plus trauma groups than in the trauma only group. In addition, edema formation was less prominent in the EtOH plus trauma group. When comparing the low-dose EtOH Plus trauma and moderate-dose EtOH Plus trauma groups, an almost normal appearance of the hippocampus was noted in the moderate-dose EtOH plus trauma group. EtOH may have a neuroprotective effect when administered at a lower dose, particularly a moderate dose, and this protection may be a result of the inhibition of NMDA receptor-mediated excitotoxicity.
