Objective: Amidst the evident challenges posed by brain tumors and the evident limitations of con... more Objective: Amidst the evident challenges posed by brain tumors and the evident limitations of conventional treatment methodologies like surgery, radiotherapy, and chemotherapy, our primary objective was to probe the therapeutic potential of high-intensity therapeutic ultrasound (HITU). The aim was to introduce a safer, cost-effective, and efficient alternative to existing treatments, especially beneficial for inaccessible brain tumor sites and resource-constrained medical facilities. Materials and methods: Leveraging post-1990s MR technology advancements, we employed the non-invasive HITU technique, akin to high-intensity focused ultrasound. This method directs acoustic energy to tissues, primarily inducing coagulation necrosis by absorbing energy and elevating tissue temperatures. Glial tumor cells were subjected to HITU to assess its effects. Results: Upon applying HITU to glial tumor cells, significant alterations in cellular structural integrity were evident. The main action of HITU was the absorption of acoustic energy, leading to a notable temperature rise and coagulation necrosis. Flow cytometry indicated significant cellular changes post-HITU. ANOVA and t-test analyses showed a significant relationship between HITU application and time (p<0.05). The Shapiro-Wilk test revealed non-normal data distribution (p<0.05), leading to the use of nonparametric methods. The t-test results after HITU displayed significant differences (p<0.05) in cell counts and fluorescence intensity between control and treated groups. This result was consistent across multiple tests, indicating the reliability of the method in causing cellular damage to the tumor cells. Conclusions: Our laboratory analyses offer compelling evidence that HITU is not merely feasible but is also a promising non-invasive approach in the treatment paradigm of brain tumors. Standing distinctively apart from radiotherapy, HITU averts early, or late complications commonly associated with the former. While the path ahead mandates comprehensive research to ascertain its clinical utility, preliminary indications firmly posit HITU as a groundbreaking prospect in the management of brain tumors.
Recent technological developments caused new methods of techniques in the treatment of brain isch... more Recent technological developments caused new methods of techniques in the treatment of brain ischemia. These methods could be categorized into two types as acute stage interventions and preventive techniques for development of ischemia. In this report, intraarterial thrombolysis, mechanical thrombectomy, intracranial angioplasty and stenting techniques were being described, which were started to be used in the world. These interventions are indirect surgery, subspecialised as neuroendovascular therapy, and require the neurologists, neurosurgeons and radiologists to work as a team. Therefore, it is possible to establish a new hybride branch caring for only stroke patients in the near future.
The aim of this clinical retrospective review was to emphasize the recently observed high inciden... more The aim of this clinical retrospective review was to emphasize the recently observed high incidence of ventriculomegaly, a wellknown complication of brain abscesses. Among twelve brain abscess cases operated on in our institution during five years, the most common surgical procedure was burr-hole aspiration applied in ten of the cases, while in the remaining two a standard craniotomy and total excision was performed. Ventriculomegaly was assessed by the &quot;Evans&#39; Ratio&quot; values calculated using the frontal ventricular horn measurements made on axial tomographic images. The signs, symptoms, radiological findings and clinical features of the patients were in accordance to the pertinent literature. The only finding worth commenting on was the surprisingly high incidence of ventriculomegaly (5/12) and periventricular edema (4/12). Concerning the outcome, there was only one death. The &quot;Evans&#39; Ratio&quot; either worsened or remained the same in four out of five cases during the early postoperative period (ranging from one to three months) and it got better in one case in the late postoperative control (1.5 years). Furthermore, periventricular edema persisted just in the same manner in three of the four cases.
Vacuum disc phenomenon is seen frequently with degenerative disc disease and is characterized by ... more Vacuum disc phenomenon is seen frequently with degenerative disc disease and is characterized by the collection of gas in the disc space. Although the accumulation of gas within the disc space does not have clinical significance, symptoms may develop when occurring within the spinal canal. We present a 60-year-old female patient with low back and left leg pain occurring for 3 months before admission to our clinic. Straight leg raise test was 50 degrees in the left leg. Magnetic resonance imaging showed a narrowing of the L5-S1 disc space with vacuum disc phenomenon and hypointense cystic mass in T1 and T2-weighted images. The decision for surgery was made and left L5-S1 hemilaminectomy and foraminotomy was performed. The cyst wall was adherent to the root and dura mater and was partially excised. The patient was pain-free on the first postoperative day. In cases of gas accumulation in the spinal canal, discogenic pain may occur. Surgical therapy is still an acceptable method for the treatment of vacuum disc phenomenon and accumulation of gas within the spinal canal.
Disc degeneration probably begins in childhood although low back pain and radicular leg pain is n... more Disc degeneration probably begins in childhood although low back pain and radicular leg pain is not as common a complaint as in adults. However as yet no explanation exists for the appearance of advanced degenerative changes seen occasionally in patients in their twenties. We report 12 adolescents between the ages of 15 and 20 among a total of 1068 cases with radiologically demonstrated lumbar disc herniations treated between March 1991 and March 1996. Most of their findings were in good agreement with earlier and more recent reports. The only different findings worth commenting upon were the common presence of multiple level disc herniations, and the occasional presence of a so called &quot;fractured epiphysial plate&quot;. Depending on magnetic resonance imaging findings coupled with computed tomographic images; we suppose that the so called &quot;fractured bone fragments of the vertebral epiphysial rim impinging on the spinal canal at multiple levels&quot; and &quot;wedges of bone attached to the disc end plate and associated bony defects in the margins of the posterior vertebral bodies&quot; reported to be demonstrated on computed tomographic (CT) images may in fact be false images. Inappropriately angled CT scan slices may cut partly through the epiphysial ring which has totally been distracted backwards together with the firmly attached avulsed disc annuli, designated as an &quot;epiphysial avulsion&quot;; giving rise to the mistaken interpretation as a &quot;fractured epiphysial ring&quot; appearance. Such a mechanism may also involve the posterior longitudinal ligament, which is firmly attached to the neighboring annuli, accounting for the common multilevel involvement.
Isolated abducens nerve palsy following lumbar puncture is a very rare condition. In this case we... more Isolated abducens nerve palsy following lumbar puncture is a very rare condition. In this case we discussed the probable causes of abducens nerve palsy and review the mechanism of action in anatomical relevant literature. A 53-year old hypertensive female patient with a saccular aneursym on the left middle cerebral artery (MCA) bifurcation underwent emergency operation. Before the operation lumbar puncture (LP) was performed to the patient lying on the right lateral position to facilitate cerebral relaxation intraoperatively. The left MCA bifurcation aneurysm was clipped successfully with a left pterional-transsylvian approach. Postoperatively, she complained of visual diplopia and postural headache. In her neurological examination, isolated abducens nerve palsy was found on the left eye. The patient was treated with intravenous hydration, bed rest and non - steroid anti-inflamatuary drugs (NSAID) for postural headache. Her postural headache was resolved in the postoperative fifth d...
Thoracic outlet compression syndrome (TOCS) is not a rare entity. It needs to be recognized, and ... more Thoracic outlet compression syndrome (TOCS) is not a rare entity. It needs to be recognized, and patients need to be analysed from a neurologic perspective. In this paper, 94 patients with TOCS admitted to Hacettepe University Hospitals, between the years 1975-1988, have been analysed in respect to age, sex, signs, symptoms and surgical techniques. A review of the literature in the management of TOCS has been made. We experienced no operative mortality and a 12% morbidity rate. We believe that more attention should be given to this diagnosis and treatment to relieve symptoms.
Purpose Long-term compaction, compression, migration, and recurrence rates of the WovenEndoBridge... more Purpose Long-term compaction, compression, migration, and recurrence rates of the WovenEndoBridge devices remain unknown. The purpose of this study was to detect these rates and safety profiles of the WovenEndoBridge within 7 years period. Materials and methods Eighty-three aneurysms of 79 patients treated with the WovenEndoBridge device were retrospectively evaluated using an occlusion scale (e.g. complete occlusion, neck remnant, and aneurysm remnant) on angiography images. Results The residual aneurysm was observed in 11 (13%) aneurysms. The mean and median diameters of the recurrent aneurysms were 6 and 7 mm. Most of the recurrent aneurysms were complex type and/or ruptured. Mean diameters and the neck-to-body ratios of all residual aneurysms in the preoperative imaging exams were above 4 mm and 0.6, respectively. The median values of preoperative height and neck measurements were higher in the recurrent aneurysms than in the adequate occlusion group ( p = 0.006, p = 0.019, resp...
Objective: Amidst the evident challenges posed by brain tumors and the evident limitations of con... more Objective: Amidst the evident challenges posed by brain tumors and the evident limitations of conventional treatment methodologies like surgery, radiotherapy, and chemotherapy, our primary objective was to probe the therapeutic potential of high-intensity therapeutic ultrasound (HITU). The aim was to introduce a safer, cost-effective, and efficient alternative to existing treatments, especially beneficial for inaccessible brain tumor sites and resource-constrained medical facilities. Materials and methods: Leveraging post-1990s MR technology advancements, we employed the non-invasive HITU technique, akin to high-intensity focused ultrasound. This method directs acoustic energy to tissues, primarily inducing coagulation necrosis by absorbing energy and elevating tissue temperatures. Glial tumor cells were subjected to HITU to assess its effects. Results: Upon applying HITU to glial tumor cells, significant alterations in cellular structural integrity were evident. The main action of HITU was the absorption of acoustic energy, leading to a notable temperature rise and coagulation necrosis. Flow cytometry indicated significant cellular changes post-HITU. ANOVA and t-test analyses showed a significant relationship between HITU application and time (p<0.05). The Shapiro-Wilk test revealed non-normal data distribution (p<0.05), leading to the use of nonparametric methods. The t-test results after HITU displayed significant differences (p<0.05) in cell counts and fluorescence intensity between control and treated groups. This result was consistent across multiple tests, indicating the reliability of the method in causing cellular damage to the tumor cells. Conclusions: Our laboratory analyses offer compelling evidence that HITU is not merely feasible but is also a promising non-invasive approach in the treatment paradigm of brain tumors. Standing distinctively apart from radiotherapy, HITU averts early, or late complications commonly associated with the former. While the path ahead mandates comprehensive research to ascertain its clinical utility, preliminary indications firmly posit HITU as a groundbreaking prospect in the management of brain tumors.
Recent technological developments caused new methods of techniques in the treatment of brain isch... more Recent technological developments caused new methods of techniques in the treatment of brain ischemia. These methods could be categorized into two types as acute stage interventions and preventive techniques for development of ischemia. In this report, intraarterial thrombolysis, mechanical thrombectomy, intracranial angioplasty and stenting techniques were being described, which were started to be used in the world. These interventions are indirect surgery, subspecialised as neuroendovascular therapy, and require the neurologists, neurosurgeons and radiologists to work as a team. Therefore, it is possible to establish a new hybride branch caring for only stroke patients in the near future.
The aim of this clinical retrospective review was to emphasize the recently observed high inciden... more The aim of this clinical retrospective review was to emphasize the recently observed high incidence of ventriculomegaly, a wellknown complication of brain abscesses. Among twelve brain abscess cases operated on in our institution during five years, the most common surgical procedure was burr-hole aspiration applied in ten of the cases, while in the remaining two a standard craniotomy and total excision was performed. Ventriculomegaly was assessed by the &quot;Evans&#39; Ratio&quot; values calculated using the frontal ventricular horn measurements made on axial tomographic images. The signs, symptoms, radiological findings and clinical features of the patients were in accordance to the pertinent literature. The only finding worth commenting on was the surprisingly high incidence of ventriculomegaly (5/12) and periventricular edema (4/12). Concerning the outcome, there was only one death. The &quot;Evans&#39; Ratio&quot; either worsened or remained the same in four out of five cases during the early postoperative period (ranging from one to three months) and it got better in one case in the late postoperative control (1.5 years). Furthermore, periventricular edema persisted just in the same manner in three of the four cases.
Vacuum disc phenomenon is seen frequently with degenerative disc disease and is characterized by ... more Vacuum disc phenomenon is seen frequently with degenerative disc disease and is characterized by the collection of gas in the disc space. Although the accumulation of gas within the disc space does not have clinical significance, symptoms may develop when occurring within the spinal canal. We present a 60-year-old female patient with low back and left leg pain occurring for 3 months before admission to our clinic. Straight leg raise test was 50 degrees in the left leg. Magnetic resonance imaging showed a narrowing of the L5-S1 disc space with vacuum disc phenomenon and hypointense cystic mass in T1 and T2-weighted images. The decision for surgery was made and left L5-S1 hemilaminectomy and foraminotomy was performed. The cyst wall was adherent to the root and dura mater and was partially excised. The patient was pain-free on the first postoperative day. In cases of gas accumulation in the spinal canal, discogenic pain may occur. Surgical therapy is still an acceptable method for the treatment of vacuum disc phenomenon and accumulation of gas within the spinal canal.
Disc degeneration probably begins in childhood although low back pain and radicular leg pain is n... more Disc degeneration probably begins in childhood although low back pain and radicular leg pain is not as common a complaint as in adults. However as yet no explanation exists for the appearance of advanced degenerative changes seen occasionally in patients in their twenties. We report 12 adolescents between the ages of 15 and 20 among a total of 1068 cases with radiologically demonstrated lumbar disc herniations treated between March 1991 and March 1996. Most of their findings were in good agreement with earlier and more recent reports. The only different findings worth commenting upon were the common presence of multiple level disc herniations, and the occasional presence of a so called &quot;fractured epiphysial plate&quot;. Depending on magnetic resonance imaging findings coupled with computed tomographic images; we suppose that the so called &quot;fractured bone fragments of the vertebral epiphysial rim impinging on the spinal canal at multiple levels&quot; and &quot;wedges of bone attached to the disc end plate and associated bony defects in the margins of the posterior vertebral bodies&quot; reported to be demonstrated on computed tomographic (CT) images may in fact be false images. Inappropriately angled CT scan slices may cut partly through the epiphysial ring which has totally been distracted backwards together with the firmly attached avulsed disc annuli, designated as an &quot;epiphysial avulsion&quot;; giving rise to the mistaken interpretation as a &quot;fractured epiphysial ring&quot; appearance. Such a mechanism may also involve the posterior longitudinal ligament, which is firmly attached to the neighboring annuli, accounting for the common multilevel involvement.
Isolated abducens nerve palsy following lumbar puncture is a very rare condition. In this case we... more Isolated abducens nerve palsy following lumbar puncture is a very rare condition. In this case we discussed the probable causes of abducens nerve palsy and review the mechanism of action in anatomical relevant literature. A 53-year old hypertensive female patient with a saccular aneursym on the left middle cerebral artery (MCA) bifurcation underwent emergency operation. Before the operation lumbar puncture (LP) was performed to the patient lying on the right lateral position to facilitate cerebral relaxation intraoperatively. The left MCA bifurcation aneurysm was clipped successfully with a left pterional-transsylvian approach. Postoperatively, she complained of visual diplopia and postural headache. In her neurological examination, isolated abducens nerve palsy was found on the left eye. The patient was treated with intravenous hydration, bed rest and non - steroid anti-inflamatuary drugs (NSAID) for postural headache. Her postural headache was resolved in the postoperative fifth d...
Thoracic outlet compression syndrome (TOCS) is not a rare entity. It needs to be recognized, and ... more Thoracic outlet compression syndrome (TOCS) is not a rare entity. It needs to be recognized, and patients need to be analysed from a neurologic perspective. In this paper, 94 patients with TOCS admitted to Hacettepe University Hospitals, between the years 1975-1988, have been analysed in respect to age, sex, signs, symptoms and surgical techniques. A review of the literature in the management of TOCS has been made. We experienced no operative mortality and a 12% morbidity rate. We believe that more attention should be given to this diagnosis and treatment to relieve symptoms.
Purpose Long-term compaction, compression, migration, and recurrence rates of the WovenEndoBridge... more Purpose Long-term compaction, compression, migration, and recurrence rates of the WovenEndoBridge devices remain unknown. The purpose of this study was to detect these rates and safety profiles of the WovenEndoBridge within 7 years period. Materials and methods Eighty-three aneurysms of 79 patients treated with the WovenEndoBridge device were retrospectively evaluated using an occlusion scale (e.g. complete occlusion, neck remnant, and aneurysm remnant) on angiography images. Results The residual aneurysm was observed in 11 (13%) aneurysms. The mean and median diameters of the recurrent aneurysms were 6 and 7 mm. Most of the recurrent aneurysms were complex type and/or ruptured. Mean diameters and the neck-to-body ratios of all residual aneurysms in the preoperative imaging exams were above 4 mm and 0.6, respectively. The median values of preoperative height and neck measurements were higher in the recurrent aneurysms than in the adequate occlusion group ( p = 0.006, p = 0.019, resp...
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