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Öğe Bilateral vertebral artery occlusion following cervical spine trauma - case report(Japan Neurosurgical Soc, 1999) Özveren, Faik; Ziyal, İbrahim M.; Bejjani, Ghassan K.; Yaymacı, Yalçın; Bilge, TurgayA 41-year-old female presented with a rare case of bilateral vertebral artery occlusion following C5-6 cervical spine subluxation after a fall of 30 feet. Digital subtraction angiography showed occlusion of the bilateral vertebral arteries. Unlocking of the facet joint, posterior wiring with iliac crest grafting, and anterior fusion were performed. The patient died on the 3rd day after the operation. This type of injury has a grim prognosis with less than a third of the patients achieving a good outcome.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 Cerebral metastasis of a uterine leiomyosarcoma - case report(Japan Neurosurgical Soc, 1999) Ziyal, İbrahim M.; Müslüman, Murat; Bejjani, Ghassan K.; Tanık, Canan; Türkmen, Cengiz S.; Aydın, Yunus38-year-old female presented with sudden neurological deterioration 6 years after an operation and chemotherapy for uterine leiomyosarcoma. An extremely rare metastasis of the uterine leiomyosarcoma to the brain was identified and totally resected. Whole brain irradiation (50 Gy) was given. A recurrence of the metastasis was resected 10 weeks later. She ultimately died of a second recurrence. Aggressive surgical management of cerebral metastasis of uterine leiomyosarcoma may achieve an improved outcome.Öğe Clinical and radiological results of lumbar microdiskectomy technique with preserving of ligamentum flavum comparing to the standard microdiskectomy technique(Elsevier Science Inc, 2002) Aydın, Yunus; Ziyal, İbrahim M.; Duman, Hüdayi; Türkmen, Cengiz S.; Başak, Muzaffer; Şahin, YükselBACKGROUND The ligamentum flavum is the anatomic plane between the epidural and laminar-extralaminar spaces, which should be meticulously preserved for a possible reoperation. Preservation of the ligamentum flavum together with other epidural-anatomic structures, such as epidural fat tissue and venous plexuses, and limited removal of the lamina are important components in preventing epidural fibrosis that may be the cause of failed back surgery syndrome. METHODS One thousand five hundred patients underwent microdiskectomy with preservation of the ligamentum flavum over an 8-year period. This technique was performed with a small incision using an 18 mm-width mini Taylor retractor. The ligamentum flavum was released and preserved as a 3-sided flap. The disk content was totally removed and a pediculated fat graft was used to cover the root at the end. Four hundred patients operated on with the ligamentum flavum preserving technique were randomly selected for this study (Group 1). Their results were compared with those of 200 patients who were operated on with the standard microdiskectomy (Group 2). Standard microdiskectomy technique was performed with fenestration and foraminotomy and the ligamentum flavum was partially or totally excised. Early clinical outcome was classified as excellent, good, fair, poor, or failure. The clinical mean follow-up period in Group 1 was 36.8 months and in Group 2 it was 32.4 months, One hundred patients from each group had computed tomographic scans with contrast administration performed at least one year after the operation to examine late epidural fibrosis. A questionnaire was given to all patients at least 3 times during the late follow-up period. The questionnaire required patients to describe their relief of pain, job performance, and abstinence from narcotic analgesic use. RESULTS Early clinical outcome (fourth postoperative week) in Group 1 was satisfactory in 96.75% of the patients, whereas it was satisfactory in only 81.5% in Group 2 (p < 0.001). The radiological examinations revealed fibrosis in 18% of the patients in Group 1 and 37% in Group 2 (p < 0.001). None of the patients in Group 1 were readmitted because of fibrosis-related symptoms. The reoperation rate in Group 1 was 4.5%. The recurrence rate was 1.75% and disc at another level was 2.5%. One patient was reoperated because of a suture granuloma. In Group 2, the reoperation rate was 9% (p < 0.05). The recurrence rate was 4.5%, disc at another level was 3.5% and extensive epidural fibrosis was 1%. Two patients who underwent surgery for epidural fibrosis in this group had disappointing outcomes. Overall success rate based on the questionnaire was 91% in Group 1 and 76% in Group 2 (P < 0.001). CONCLUSIONS The ligamentum flavum preserving technique is useful in achieving a favorable long-term outcome, and reoperation, if necessary, is easier and safer.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 Delici kranyoserebral ateşli silah yaralanmaları(1999) Ziyal, İbrahim M.; Kılınçoğlu, Bülent F.; Şahin, Yüksel; Aydın, YunusKranyoserebral ateşli silah yaralanmaları sıklıkla savaş dönemlerinde görülmekle birlikte, sivil hayatın da nadir kafa travması sebeplerinden biridir. Bu çalışmada, son dört yıl içinde ateşli silah yaralanması sonucu kafa travması geçiren 29 sivil yaralanma olgusu tanı, tedavi ve takip sonuçları ile birlikte literatür gözden geçirilerek özetlendi. Kurşun yaralanması 21 olguda, saçma ile yaralanma ise 8 olguda tesbit edildi. Olguların kliniğe kabulleri esnasındaki Glasgow Koma Skalaları (GKS) 12 olguda 3-7 arası, 11 olguda 8-11 arası ve 6 olguda 12-15 arası idi. Travmatik subaraknoid kanama (SAK) 27 olguda (%93), pnömosefalus 26 olguda (% 83), ayrıca 6 olguda intraserebral hematom, 4 olguda geniş kranyal defekt ve 2 olguda intraventriküler kanama tabloya eşlik etmekte idi. Ondokuz olguda mermi çekirdeğinin ya da saçmanın kafayı terk etmiş olduğu, on olguda ise kranyum içinde kalmış olduğu tesbit edildi. Cerrahi girişim 10 olguya uygulandı. Sadece bir olguda mermi çekirdeği çıkartıldı, ancak bu olguda cerrahi endikasyon kurşunun çıkarılması değil intraserebral hematomun boşaltılması idi. İki olguda geç dönemde abse tesbit edildi. Bu serinin mortalite oranı % 34 olarak tesbit edildi. Hayatta kalan 19 olgunun ortalama takip süresi 26 ay idi ve sadece 2 olgu hiçbir nörolojik defisit veya sekel olmaksızın yaşamını devam ettirmektedir. Ayrıca iki olguda zaman içinde kranyum içindeki kurşunun yer değiştirmiş olduğu tesbit edildi.Öğe Extradural posterior inferior cerebellar artery(Amer Assoc Neurological Surgeons, 2000) Ziyal, İbrahim M.; Salas, EduardoWe read with great interest the paper by Fine and colleagues (Fine AD, Cardosa A, Rhoton AL: Microsurgical anatomy of the extracranial–extradural origin of the posterior inferior cerebellar artery. J Neurosurg 91:645–652, October, 1999). The authors have provided an excellent anatomical description of the extradural–extracranial posterior inferior cerebellar artery (PICA). In their specimen, the right PICA arose 7 mm proximal to the dural ring. The vertebral artery (VA) at that point was 5.5 mm in diameter and the PICA diameter at the origin was 2.5 mm. The left PICA arose 6 mm proximal to the dural ring. At the PICA origin, the VA was 5 mm and the PICA was 2.2 mm in diameter. Both PICAs arose from the posterior surface of the VAs.Öğe Extradural posterior inferior cerebellar artery [5] (multiple letters)(2000) Ziyal, İbrahim M.; Salas, E.; Rhoton A.L., Jr.; Fine, A.D.; Cardoso, A.[No abstract available]Öğe Migration of the abdominal catheter of a ventriculoperitoneal shunt into the scrotum(Japan Neurosurgical Soc, 1999) Özveren, M. Faik; Kazez, Ahmet; Çetin, Hasan; Ziyal, İbrahim M.A 3-day-old male neonate presented with migration of the ventriculoperitoneal (VP) shunt tip through the patent processus vaginalis resulting in scrotal hydrocele. The association of myelomeningocele with hydrocephalus may have been a predisposing factor in this rare complication. Development of scrotal swelling or hydrocele in a child with VP shunt should be recognized as a possible shunt complication.Öğe Multiple meningiomas and intracranial aneurysms: a case report and review of the literature(Springer Heidelberg, 1998) Ziyal, İbrahim M.; Aydın, Yunus; Bejjani, Ghassan K.; Kaya, Alper R.; Duman, HüdayiAn extremely rare case with multiple meningiomas and multiple aneurysms is reported. This 48 year-old female had her meningiomas at the convexity and along the sphenoid wing, and intracranial aneurysms at the basilar tip, left middle cerebral artery bifurcation, and left pericallosal artery. All of them were shown by preoperative radiological evaluation. During the operation, two more meningiomas, again at the sphenoid wing and at the tentorium, were found. There was no evidence of either a connective tissue disease or neurofibromatosis.Öğe The natural history of late diagnosed or untreated growing skull fractures: report on two cases(Springer-Verlag Wien, 1998) Ziyal, İbrahim M.; Aydın, Yunus; Türkmen, Cengiz S.; Salas, Eduardo; Kaya, Alper Ramazan; Özveren, FaikGrowing skull fractures (GSF) are rare complications of head trauma. Cases after childhood are extremely rare and demonstrate complicated pathological conditions which necessitate extensive treatment. We report on two rare cases of intracranial cysts related to growing skull fractures which are secondary to trauma sustained during childhood, and have been discovered in adolescence.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 Posttravmatik beyin omurilik sıvısı fistüllerine yaklaşım(1999) Ziyal, İbrahim M.; Kılınçoğlu, Bülent F.; Şahin, Yüksel; Aydın, YunusPosttraumatic Cerebrospinal Fistulas (PBF) are serious complications of head trauma which may cause to morbidity and mortality. Usually, they present with rhinorrhea or otorrhea, and they occur acutely in the first week after the trauma, rarely months and years later. In this retrospective study, from 2850 patients suffered head trauma, 48 (% 0.16) of them had PBF. The most frequent etiology was traffic accident in 34 (% 70) cases. Fifteen (%31.5) of all cases had temporal bone fracture; 8 of them had also petrous bone fracture, 31 (% 64.5) cases had parietal bone fracture; 12 of them had also ethmoid bone fracture, 2 (% 4.1) cases had fronto-parietal open depression fracture, also with fracture in the anterior fossa and the ethmoid bone. Rhinorrhea was encountered in 35 (% 73) cases, and otorrhea in 13 (% 27) cases. All patients, except four of them, admitted in 48 hours after the trauma (acute). Ten patients were treated surgically who were unresponded to the conservative treatment. Bifrontal craniotomy with extradural and/or intradural anterior fossa eksploration was performed. Primer repair could be achieved only in one case, eight cases were treated with galea greft, one case with fascia lata greft. Additionally, 8 cases needed the use of fibrin glue, and one case siyanoacrilate. The success of surgical treatment was 100%, and no postoperative fistul formation was observed. Two cases had meningitis on admission. During hospital stay, any case in this series developed meningitis. All patients were treated with prophylactic two combinations antibiotic therapy. For the precise evaluation of PBF, the efficacy of the conservative treatment and prophylactic antibiotic therapy, surgical indications of resistant cases, and appropriate surgical treatment was discussed with literature review.Öğe Propofol, tiopental ve etomidatın kortikal ve striatal infarkt üzerindeki nöroprotektif etkilerinin endovasküler reversibl iskemi modelinde karşılaştırılması: Ratlarda deneysel bir çalışma(1999) Ziyal, İbrahim M.; Salas, Eduardo; Wells-Roth, DavidNoninvaziv endovasküler reversibl serebral iskemi modeli kullanılarak 40 Sprague-Dawley ratta propofol, tiopental ve etomidatın kortikal ve striatal infarkt üzerindeki nöroprotektif etkileri çalışıldı. Total infarkt volümü (kortikal ve subkortikal) propofol (20±8.8), tiopental (25±15) ve etomidat (18±7.9) uygulanan deney gruplarında kontrol grubu (71±6.9) ile karşılaştırıldığında anlamlı bir şekilde azalmış olduğu tesbit edildi (p<0.005). Sadece kortikal infarkt volümünün propofol (5.2±4.7), tiopental (12±9.1) ve etomidat (7.2±4.9) uygulanan deney gruplarında kontrol grubu (43±7.0) ile karşılaştırıldığında anlamlı bir şekilde azalmakta idi (p< 0.005). Yine striatal infarkt volümü tiopental (8.0±1.8) ve etomidat (6.8±2.2) uygulanan deney hayvanlarında kontrol grubu (16±2.0) ile karşılaştırıldığında anlamlı bir şekilde azaltmakta idi (p< 0.05). Buna karşılık propofol (12±4.7) striatal infarkt genişliğini azaltmada etkili olamadı. Sonuç olarak propofol, tiopental ve etomidatın ratlarda geçici MCA oklüzyonuna sekonder olarak kortikal infarkt volümünü azaltmada eşit etki oluşturdukları, buna karşılık propofolün tiopental ve etomidattan farklı olarak striatal infarkt genişliğini azaltmada yeterince etki olamadığı gösterildi.
