To examine the surgical results of unilateral lumbar discectomy in patients with bilateral leg pa... more To examine the surgical results of unilateral lumbar discectomy in patients with bilateral leg pain and discuss short- and long-term outcomes within the limits of lumbar decompression. We analyzed 60 patients with unilateral disk herniation who underwent unilateral lumbar discectomy and hemipartial laminectomy between 2014 and 2017. Group 1 (30 patients) had bilateral leg pain and unilateral lumbar disk herniation. Pain lateralization was determined radiologically. Group 2 (30 patients) had unilateral leg pain and unilateral lumbar disk herniation. Pain scores were preoperatively evaluated with Visual Analog Scale (VAS) for both legs and Oswestry Disability Index (ODI) for overall life quality. In both groups, surgery was performed on the ipsilateral side of the herniated disc. Scores were repeated on postoperative day 1 and 1, 3, 6, 12, and 24 months later. VAS score differences for pain lateralization and disk levels were compared in group 1. ODI score differences were compared be...
Complex Regional Pain Syndrome Type I (CRPS-I) is a debated health problem concerning its pathoph... more Complex Regional Pain Syndrome Type I (CRPS-I) is a debated health problem concerning its pathophysiology and treatment strategies. A 12-year-old boy and a 35-year-old woman were diagnosed with CRPS-I at different times. They had previously undergone various types of interventions with no success. After one year of follow-up and observation, DREZ lesioning operation was performed. Afterwards, both cases had transient lower extremity ataxia. The first case was followed for 60 months with no recurrence and total cure. The second case was pain-free until the 6th month, when she required psychological support; she was followed for 33 months with partial satisfactory outcome. Although not a first-line option, DREZ lesioning procedure can be chosen and may be a curative option in selected cases of CRPS-I who are unresponsive to conventional therapies.
Several medical and surgical procedures have been presented for treatment of dystonia. Thalamotom... more Several medical and surgical procedures have been presented for treatment of dystonia. Thalamotomy, pallidotomy, and campotomy are some of the surgical choices. This study presents a patient with dystonia who underwent a cervical dorsal root entry zone (DREZ) operation after thalamotomy and campotomy. A 23-year-old man who was resistant to medical treatment presented with left hemidystonia. Thalamotomy and campotomy were performed. The patient remarkably benefited from the procedure but dystonic complaints in his left arm continued. A cervical DREZ operation was performed 5 years after the first operation and the dystonic complaints decreased after the surgery. This article presents a new aspect for the treatment of dystonia. Based on the outcomes of the treatment, DREZ operation may be suggested as an alternative surgical treatment for patients with segmental dystonia located in the extremities.
OBJECTIVE Although several clinical applications of transpedicular screw fixation in the cervical... more OBJECTIVE Although several clinical applications of transpedicular screw fixation in the cervical spine have been documented recently, few anatomic studies concerning the cervical pedicle are available. This study was designed to evaluate the anatomy and adjacent neural relationships of the middle and lower cervical pedicle (C3–C7). The main objective is to provide accurate information for transpedicular screw fixation in the cervical region and to minimize complications by providing a three-dimensional orientation. METHODS Twenty cadavers were used to observe the cervical pedicle and its relationships. After removal of the posterior bony elements, including spinous processes, laminae, lateral masses, and inferior and superior facets, the isthmus of the pedicle was exposed. Pedicle width, pedicle height, interpedicular distance, pedicle-inferior nerve root distance, pedicle-superior nerve root distance, pedicle-dural sac distance, medial pedicle-dural sac distance, mean angle of the...
The objective of this study was to investigate the ligaments in the exit zone of lumbar foramen a... more The objective of this study was to investigate the ligaments in the exit zone of lumbar foramen and describe their anatomic relationships with adjacent structures. Few studies have been reported on the ligaments of foramen and the anatomic relationships on the lumbar level. The ligament described in this study is novel since it has not been reported previously. Ten male and five female cadavers were used to investigate intraforaminal area and ligaments of the lumbar level. The cadavers were filled with colored latex, and the lumbar foramen were examined under operative microscope. A lumbar foramen branched off into two or three main passages, composed of inverted Y ligament form. The medial lower arm of Y ligament was attached to the upper and anterior surface of the superior articular process of the lower corpus vertebra. Its lateral lower arm was attached to the upper surface of the area where the lower corpus vertebra and its pedicle met, and the upper arm was attached to the lower surface of the pedicle of upper vertebra where it met with transverse process. The anatomic properties of vascular and nervous structures in foramen and the relations among them are described. The ligament detected in the study was different from the other reported descriptions of foraminal ligaments. It divided the lumbar foramen into three passages. Because of its relations with adjacent structures, such as nerves and vessels, the inverted Y ligament may be an important structure for lumbar foramen. Thus, it may be an important anatomic landmark.
Objective: The destruction of the descending trigeminal tractus in the medulla is known as trigem... more Objective: The destruction of the descending trigeminal tractus in the medulla is known as trigeminal tractotomy (TR), whereas the lesioning of the nucleus caudalis is known as trigeminal nucleotomy (NC). Trigeminal TR and/or NC procedures can be used in a large group of pain syndromes, such as glossopharyngeal, vagal, and geniculate neuralgias, atypical facial pain, craniofacial cancer pain, postherpetic neuralgias, and atypical forms of trigeminal neuralgia. Methods: In this study, anatomic and technical details of the procedure and the experience gained from 65 patients over the course of 20 years are discussed. Patients’ pain scores and Karnofsky Performance Scale scores were evaluated pre- and postoperatively (postoperative Day 1). Results: The best results were obtained in the second-largest group (vagoglossopharyngeal neuralgia, n = 17) and in geniculate neuralgia (n = 4). Patients with atypical facial pain (n = 21; 13 women, eight men) accounted for the largest group to unde...
Object Although infrequent, injury to adjacent neurovascular structures during posterior approach... more Object Although infrequent, injury to adjacent neurovascular structures during posterior approaches to lumbar intervertebral discs can occur. A detailed anatomical knowledge of relationships may decrease surgical complications. Methods Ten formalin-fixed male cadavers were used for this study. Posterior exposure of the lumbar thecal sac, nerve roots, pedicles, and intervertebral discs was performed. To identify retroperitoneal structures at risk during posterior lumbar discectomy, a transabdominal retroperitoneal approach was performed, and observations were made. The distances between the posterior and anterior edges of the lumbar intervertebral discs were measured, and the relationships between the disc space, pedicle, and nerve root were evaluated. Results For right and left sides, the mean distance from the inferior pedicle to the disc gradually increased from L1–2 to L4–5 (range 2.7–3.8 mm and 2.9–4.5 mm for right and left side, respectively) and slightly decreased at L5–S1. Fo...
Object The branching structure of the middle cerebral artery (MCA) remains a debated issue. In th... more Object The branching structure of the middle cerebral artery (MCA) remains a debated issue. In this study the authors aimed to describe this branching structure in detail. Methods Twenty-seven fresh, human brains (54 hemispheres) obtained from routine autopsies were used. The cerebral arteries were first filled with colored latex and contrast agent, followed by fixation with formaldehyde. All dissections were done under a microscope. During examination, the trunk structures of the MCA and their relations with cortical branches were demonstrated. Lateral radiographs of the same hemispheres were then obtained and comparisons were made. Angles between the MCA trunks were measured on 3D CT cerebral angiography images in 25 patients (50 hemispheres), and their correlations with the angles obtained in the cadaver brains were evaluated. Results A new classification was made in relation to the terminology of the intermediate trunk, which is still a subject of debate. The intermediate trunk ...
Object Knowledge of the cranium projections of the gyral structures is essential to reduce the su... more Object Knowledge of the cranium projections of the gyral structures is essential to reduce the surgical complications and to perform minimally invasive interventions in daily neurosurgical practice. Thus, in this study the authors aimed to provide detailed information on cranial projections of the eloquent cortical areas. Methods Ten formalin-fixed adult human skulls were obtained. Using sutures and craniometrical points, the crania were divided into 8 windows: superior frontal, inferior frontal, superior parietal, inferior parietal, sphenoidal, temporal, superior occipital, and inferior occipital. The projections of the precentral gyrus, postcentral gyrus, inferior frontal gyrus, superior temporal gyrus, transverse temporal gyri, Heschl gyrus, genu and splenium of the corpus callosum, supramarginal gyrus, angular gyrus, calcarine sulcus, and sylvian fissure to cranial vault were evaluated. Results Three-fourths of the precentral gyrus and postcentral gyrus were in the superior pari...
Object The vascularization pattern of the anatomy of the distal anterior cerebral artery (ACA) re... more Object The vascularization pattern of the anatomy of the distal anterior cerebral artery (ACA) remains a subject of debate. The authors provide detailed information about the distal ACA and shed light on issues concerning it that have not previously been adequately discussed. Methods Fifty adult human brains (100 hemispheres) were obtained during routine autopsies. Cerebral arteries were separately cannulated and injected with latex. The vascularization patterns of the cortical branches and the variations of the arteries were investigated. The authors found that the distal ACA supplied all the inner surfaces of the frontal and parietal lobes and a median of one third of the outer surfaces. The origin of the arteries from the main trunk and their exit angles affected the vascularization patterns of the hemispheres. The authors redefine controversial terminology regarding the callosomarginal artery. Conclusions In each hemisphere, the vascularization pattern of the distal ACA is diffe...
We present a surgical series of 35 patients (25 males and 10 females) with histopathologically ve... more We present a surgical series of 35 patients (25 males and 10 females) with histopathologically verified intracranial cavernous angiomas. The 35 malformations were located as follows: 21 were in the cerebral hemispheres; 4 in the lateral ventricles, 4 in the brain stem; and 6 in the cerebellum. Seizures and focal neurological deficits were the main clinical features observed in patients with intracranial cavernous angiomas. A number of these vascular malformations were misdiagnosed by computerized tomography. In the last 10 years, magnetic resonance imaging has been the most sensitive method for detecting these lesions. Thirty-five cavernous angiomas were treated surgically; in 33 patients a complete excision, and in 2 patients subtotal excision were obtained. One of the patients died one year after the operation. The overall outcome was good in all of the 34 remaining patients, resulting in improved seizure control or neurological deficit. The rationale for neurologic differential diagnosis and surgical treatment and follow up results are discussed.
To examine the surgical results of unilateral lumbar discectomy in patients with bilateral leg pa... more To examine the surgical results of unilateral lumbar discectomy in patients with bilateral leg pain and discuss short- and long-term outcomes within the limits of lumbar decompression. We analyzed 60 patients with unilateral disk herniation who underwent unilateral lumbar discectomy and hemipartial laminectomy between 2014 and 2017. Group 1 (30 patients) had bilateral leg pain and unilateral lumbar disk herniation. Pain lateralization was determined radiologically. Group 2 (30 patients) had unilateral leg pain and unilateral lumbar disk herniation. Pain scores were preoperatively evaluated with Visual Analog Scale (VAS) for both legs and Oswestry Disability Index (ODI) for overall life quality. In both groups, surgery was performed on the ipsilateral side of the herniated disc. Scores were repeated on postoperative day 1 and 1, 3, 6, 12, and 24 months later. VAS score differences for pain lateralization and disk levels were compared in group 1. ODI score differences were compared be...
Complex Regional Pain Syndrome Type I (CRPS-I) is a debated health problem concerning its pathoph... more Complex Regional Pain Syndrome Type I (CRPS-I) is a debated health problem concerning its pathophysiology and treatment strategies. A 12-year-old boy and a 35-year-old woman were diagnosed with CRPS-I at different times. They had previously undergone various types of interventions with no success. After one year of follow-up and observation, DREZ lesioning operation was performed. Afterwards, both cases had transient lower extremity ataxia. The first case was followed for 60 months with no recurrence and total cure. The second case was pain-free until the 6th month, when she required psychological support; she was followed for 33 months with partial satisfactory outcome. Although not a first-line option, DREZ lesioning procedure can be chosen and may be a curative option in selected cases of CRPS-I who are unresponsive to conventional therapies.
Several medical and surgical procedures have been presented for treatment of dystonia. Thalamotom... more Several medical and surgical procedures have been presented for treatment of dystonia. Thalamotomy, pallidotomy, and campotomy are some of the surgical choices. This study presents a patient with dystonia who underwent a cervical dorsal root entry zone (DREZ) operation after thalamotomy and campotomy. A 23-year-old man who was resistant to medical treatment presented with left hemidystonia. Thalamotomy and campotomy were performed. The patient remarkably benefited from the procedure but dystonic complaints in his left arm continued. A cervical DREZ operation was performed 5 years after the first operation and the dystonic complaints decreased after the surgery. This article presents a new aspect for the treatment of dystonia. Based on the outcomes of the treatment, DREZ operation may be suggested as an alternative surgical treatment for patients with segmental dystonia located in the extremities.
OBJECTIVE Although several clinical applications of transpedicular screw fixation in the cervical... more OBJECTIVE Although several clinical applications of transpedicular screw fixation in the cervical spine have been documented recently, few anatomic studies concerning the cervical pedicle are available. This study was designed to evaluate the anatomy and adjacent neural relationships of the middle and lower cervical pedicle (C3–C7). The main objective is to provide accurate information for transpedicular screw fixation in the cervical region and to minimize complications by providing a three-dimensional orientation. METHODS Twenty cadavers were used to observe the cervical pedicle and its relationships. After removal of the posterior bony elements, including spinous processes, laminae, lateral masses, and inferior and superior facets, the isthmus of the pedicle was exposed. Pedicle width, pedicle height, interpedicular distance, pedicle-inferior nerve root distance, pedicle-superior nerve root distance, pedicle-dural sac distance, medial pedicle-dural sac distance, mean angle of the...
The objective of this study was to investigate the ligaments in the exit zone of lumbar foramen a... more The objective of this study was to investigate the ligaments in the exit zone of lumbar foramen and describe their anatomic relationships with adjacent structures. Few studies have been reported on the ligaments of foramen and the anatomic relationships on the lumbar level. The ligament described in this study is novel since it has not been reported previously. Ten male and five female cadavers were used to investigate intraforaminal area and ligaments of the lumbar level. The cadavers were filled with colored latex, and the lumbar foramen were examined under operative microscope. A lumbar foramen branched off into two or three main passages, composed of inverted Y ligament form. The medial lower arm of Y ligament was attached to the upper and anterior surface of the superior articular process of the lower corpus vertebra. Its lateral lower arm was attached to the upper surface of the area where the lower corpus vertebra and its pedicle met, and the upper arm was attached to the lower surface of the pedicle of upper vertebra where it met with transverse process. The anatomic properties of vascular and nervous structures in foramen and the relations among them are described. The ligament detected in the study was different from the other reported descriptions of foraminal ligaments. It divided the lumbar foramen into three passages. Because of its relations with adjacent structures, such as nerves and vessels, the inverted Y ligament may be an important structure for lumbar foramen. Thus, it may be an important anatomic landmark.
Objective: The destruction of the descending trigeminal tractus in the medulla is known as trigem... more Objective: The destruction of the descending trigeminal tractus in the medulla is known as trigeminal tractotomy (TR), whereas the lesioning of the nucleus caudalis is known as trigeminal nucleotomy (NC). Trigeminal TR and/or NC procedures can be used in a large group of pain syndromes, such as glossopharyngeal, vagal, and geniculate neuralgias, atypical facial pain, craniofacial cancer pain, postherpetic neuralgias, and atypical forms of trigeminal neuralgia. Methods: In this study, anatomic and technical details of the procedure and the experience gained from 65 patients over the course of 20 years are discussed. Patients’ pain scores and Karnofsky Performance Scale scores were evaluated pre- and postoperatively (postoperative Day 1). Results: The best results were obtained in the second-largest group (vagoglossopharyngeal neuralgia, n = 17) and in geniculate neuralgia (n = 4). Patients with atypical facial pain (n = 21; 13 women, eight men) accounted for the largest group to unde...
Object Although infrequent, injury to adjacent neurovascular structures during posterior approach... more Object Although infrequent, injury to adjacent neurovascular structures during posterior approaches to lumbar intervertebral discs can occur. A detailed anatomical knowledge of relationships may decrease surgical complications. Methods Ten formalin-fixed male cadavers were used for this study. Posterior exposure of the lumbar thecal sac, nerve roots, pedicles, and intervertebral discs was performed. To identify retroperitoneal structures at risk during posterior lumbar discectomy, a transabdominal retroperitoneal approach was performed, and observations were made. The distances between the posterior and anterior edges of the lumbar intervertebral discs were measured, and the relationships between the disc space, pedicle, and nerve root were evaluated. Results For right and left sides, the mean distance from the inferior pedicle to the disc gradually increased from L1–2 to L4–5 (range 2.7–3.8 mm and 2.9–4.5 mm for right and left side, respectively) and slightly decreased at L5–S1. Fo...
Object The branching structure of the middle cerebral artery (MCA) remains a debated issue. In th... more Object The branching structure of the middle cerebral artery (MCA) remains a debated issue. In this study the authors aimed to describe this branching structure in detail. Methods Twenty-seven fresh, human brains (54 hemispheres) obtained from routine autopsies were used. The cerebral arteries were first filled with colored latex and contrast agent, followed by fixation with formaldehyde. All dissections were done under a microscope. During examination, the trunk structures of the MCA and their relations with cortical branches were demonstrated. Lateral radiographs of the same hemispheres were then obtained and comparisons were made. Angles between the MCA trunks were measured on 3D CT cerebral angiography images in 25 patients (50 hemispheres), and their correlations with the angles obtained in the cadaver brains were evaluated. Results A new classification was made in relation to the terminology of the intermediate trunk, which is still a subject of debate. The intermediate trunk ...
Object Knowledge of the cranium projections of the gyral structures is essential to reduce the su... more Object Knowledge of the cranium projections of the gyral structures is essential to reduce the surgical complications and to perform minimally invasive interventions in daily neurosurgical practice. Thus, in this study the authors aimed to provide detailed information on cranial projections of the eloquent cortical areas. Methods Ten formalin-fixed adult human skulls were obtained. Using sutures and craniometrical points, the crania were divided into 8 windows: superior frontal, inferior frontal, superior parietal, inferior parietal, sphenoidal, temporal, superior occipital, and inferior occipital. The projections of the precentral gyrus, postcentral gyrus, inferior frontal gyrus, superior temporal gyrus, transverse temporal gyri, Heschl gyrus, genu and splenium of the corpus callosum, supramarginal gyrus, angular gyrus, calcarine sulcus, and sylvian fissure to cranial vault were evaluated. Results Three-fourths of the precentral gyrus and postcentral gyrus were in the superior pari...
Object The vascularization pattern of the anatomy of the distal anterior cerebral artery (ACA) re... more Object The vascularization pattern of the anatomy of the distal anterior cerebral artery (ACA) remains a subject of debate. The authors provide detailed information about the distal ACA and shed light on issues concerning it that have not previously been adequately discussed. Methods Fifty adult human brains (100 hemispheres) were obtained during routine autopsies. Cerebral arteries were separately cannulated and injected with latex. The vascularization patterns of the cortical branches and the variations of the arteries were investigated. The authors found that the distal ACA supplied all the inner surfaces of the frontal and parietal lobes and a median of one third of the outer surfaces. The origin of the arteries from the main trunk and their exit angles affected the vascularization patterns of the hemispheres. The authors redefine controversial terminology regarding the callosomarginal artery. Conclusions In each hemisphere, the vascularization pattern of the distal ACA is diffe...
We present a surgical series of 35 patients (25 males and 10 females) with histopathologically ve... more We present a surgical series of 35 patients (25 males and 10 females) with histopathologically verified intracranial cavernous angiomas. The 35 malformations were located as follows: 21 were in the cerebral hemispheres; 4 in the lateral ventricles, 4 in the brain stem; and 6 in the cerebellum. Seizures and focal neurological deficits were the main clinical features observed in patients with intracranial cavernous angiomas. A number of these vascular malformations were misdiagnosed by computerized tomography. In the last 10 years, magnetic resonance imaging has been the most sensitive method for detecting these lesions. Thirty-five cavernous angiomas were treated surgically; in 33 patients a complete excision, and in 2 patients subtotal excision were obtained. One of the patients died one year after the operation. The overall outcome was good in all of the 34 remaining patients, resulting in improved seizure control or neurological deficit. The rationale for neurologic differential diagnosis and surgical treatment and follow up results are discussed.
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