Browsing by Author "Yilmaz, Cem"

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Analysis of geriatric patients with minor spinal trauma admitted to the emergency department of a university hospital
(2019) Giray, Tufan Akin; Kayipmaz, Afsin Emre; Sonmez, Erkin; Haberal, Kemal Murat; Yilmaz, Cem; Kavalci, Cemil; Oguzturk, Hakan
Objective: To retrospectively analyze patients aged 65 years and over, who were admitted to a level II trauma center in Turkey due to minor spinal trauma in a period of 4 years. Methods: The study included 64 patients aged 65 years and over, who were admitted to the Emergency Department of Baskent University Ankara Hospital between January 2011 and January 2015 and diagnosed with vertebral trauma. The information of the patients was obtained from the medical records. The clinical characteristics of patients including localizations and types of fracture, presence of additional system injuries and treatment options were investigated. Results: The most common cause was fall, accounting for 51 (79.7%), with 7 (10.9%) due to intra-vehicle traffic accident, and 6 (9.4%) due to out-of-vehicle pedestrian injury. The most common site of trauma was the lumbar region. Of the fractures, 46.9% (n=30) were in the lumbar region, 37.5% (n=24) in the thoracic region and 15.6% (n=10) were in the cervical vertebra region. Fourteen (21.9%) patients had an additional injury. Given the fracture types, 47 fractures (74.6%) were compression, 14 fractures (22.2%) were spinous process and 2 fractures (3.2%) were burst fractures. Twenty patients (31.2%) had multilevel vertebral fractures. Conclusions: The results of our study demonstrated the importance of vertebral fractures in the geriatric age group. In this age group, falls and motor vehicle accidents are the leading causes of vertebral traumas. Taking the necessary measures to prevent the risk factors which increase with aging is the most important step in preventing the mortality and morbidity that may occur as a result of vertebral fracture.
Association Between Brain Venous Drainage, Cerebral Aneurysm Formation and Aneurysm Rupture
(2017) Duman, Enes; Coven, Ilker; Yildirim, Erkan; Yilmaz, Cem; Pinar, H.Ulas; Ozdemir, Ozgur; 0000-0003-0473-6763; 0000-0002-9057-722X; 0000-0002-2353-8044; 27593813; Q-2420-2015; ABI-3856-2020; AAK-2948-2021
AIM: The brain venous drainage dominance is generally divided into three groups; right or left dominance and co-dominance. There is no study in the literature examining the link between brain venous drainage and aneurysm formation or rupture. Our aim was to evaluate the association between venous dominancy, aneurysm formation and rupture. MATERIAL and METHODS: Eighty-six patients, who underwent cerebral digital subtraction angiography and who had cerebral aneurysms, were included in the study. The angiographic images, patient charts, and tomography images were scanned retrospectively. We recorded the aneurysm's location, size, dome to neck ratio (D/N); the patient's gender, age, whether there was a ruptured aneurysm, smoking history, and/or hypertension; dominance of venous drainage, aneurysm side, Fisher scores and the World Federation of Neurosurgical Societies (WFNS) Grading System for Subarachnoid Hemorrhage scores for patients who had a ruptured aneurysm. We assessed whether or not venous drainage was associated with rupture of the aneurysm and if venous dominance was a predisposing factor for aneurysm formation like location, size, and hypertension. RESULTS: There was a statistically significant association between venous dominance and side of aneurysm; and also a statistically significant association between venous dominance and rupture. There was a positive correlation between hypertension and rupture. The most common aneurysm location was the anterior communicating artery, followed by the middle cerebral artery. CONCLUSION: Brain venous drainage dominance may be a predisposing factor for aneurysm formation and it can be predictive for rupture.
Balloon Kyphoplasty Is a Safe and Effective Option for the Treatment of Vertebral Compression Fractures in Solid-Organ Transplant Recipients
(2020) Sonmez, Erkin; Comert, Serhat; Akdur, Aydincan; Karakaya, Emre; Gulsen, Salih; Yilmaz, Cem; Altinors, Nur; Haberal, Mehmet; 0000-0002-7535-1804; 0000-0002-8726-3369; 0000-0002-3462-7632; 0000-0002-5693-3542; 0000-0002-4879-7974; 0000-0002-2353-8044; 27063841; AAJ-5746-2021; AAA-3068-2021; AAJ-8097-2021; AAI-8820-2021; AAD-5466-2021; AAK-2948-2021
Objectives: Solid-organ transplant recipients are at great risk for osteoporotic vertebral compression fractures because of both underlying pretransplant bone diseases and posttransplant immunosuppressive treatments. Balloon kyphoplasty is a minimally invasive procedure that is used to treat painful osteoporotic vertebral compression fractures. It involves injection of polymethylmethacrylate into the vertebral body to stabilize the fracture and to alleviate the pain immediately. In this study, we report the results of balloon kyphoplasty for treatment of vertebral compression fractures in solid-organ transplant recipients. Materials and Methods: We retrospectively reviewed 512 liver transplant and 2248 kidney transplant procedures that were performed in our center between 1985 and 2015. Seven transplant recipients with a total of 10 acute, symptomatic vertebral compression fractures who were unresponsive to conservative treatment for 3 weeks underwent balloon kyphoplasty. Clinical outcome was graded using the visual analog scale. Radiographic evaluation included measurement of the segmental kyphosis by the Cobb method. Results: There were 4 female and 3 male patients in our study group. Ages of patients ranged from 56 to 63 years with an average age of 58.8 years. The affected vertebral levels varied from T12 to L4. Mean follow-up after balloon kyphoplasty was 3.4 years, and mean time interval from transplant to balloon kyphoplasty was 8.6 years. Statistically significant difference is evident 3 years after transplant surgery (P < .05). Sagittal alignment improved (> 5 degrees) in 2 of 7 patients (28%). Conclusions: Transplant recipients are at great risk in terms of vertebral compression fracture development, especially within 1 year after transplant. Although conservative treatment has been the first treatment choice for vertebral compression fracture, long treatment time and high costs may be needed to achieve cure. Experience with our small patient population showed that balloon kyphoplasty was effective and safe for obtaining rapid pain relief and earlier mobilization with fewer complications.
Biphasic Pulmonary Blastoma Associated with Cerebral Metastasis
(2016) Kilic, Dalokay; Yilmaz, Cem; Tepeoglu, Merih; Vural, Cigdem; Caner, Hakan; 26768884
Pulmonary blastoma is a very rare malignant tumor of the lungs. A biphasic pulmonary blastoma was histologically diagnosed by a characteristic finding as it was mainly constituted of immature tumor tissue that had both epithelial and mesenchymal components. We present a case of a 68-year-old man with biphasic pulmonary blastoma. The patient underwent cranial metastatectomy and left lung upper lobectomy. Although the tumor was resected, there was rapid metastasis to the cranial, liver, kidney and multiple bones. Although radiotherapy and chemotherapy were administrated, the patient died about 6 months postoperatively. Close follow-up and aggressive chemotherapy should be considered for such tumours. In the light of this case, the authors review the pathologic, clinical, radiological and therapeutic features of this very rare malignant lung tumor.
The Effect of Pycnogenol (R) on Spatial Learning and Memory in Rats with Experimental Closed Head Injury
(2017) Kayipmaz, Afsin Emre; Erdem, Remzi; Yilmaz, Cem; Deniz, Emine Ebru; Kavalci, Cemil; Ozdemir, Alperen; Guler, Irem; Caferoglu, Eda; Kalyoncu, Fatma Serra; Guven, Ozgur; 0000-0002-2353-8044; AAK-2948-2021; AAC-2597-2020
Aim: Trauma is a leading cause of emergency admissions. In this study, we investigated the effect of Pycnogenol (R) on spatial learning and memory (SLM) function in rats subjected to closed head injury. Methods: The study was a randomized, experimental study of four groups, each containing six rats. Pycnogenol (R) was administered to rats in two groups (group three and four) daily for five days starting on day one. A Barnes maze was used to test SLM in the rats in all four groups. Group 1: These rats did not have a closed head injury and were not administered Pycnogenol (R). Group 2: On the day three, closed head trauma was inflicted. Group 3: Pycnogenol (R) was administered to the rats. On day three, closed head trauma was inflicted. Group 4: Only Pycnogenol (R) was administered. At the end of day five, the brain tissue of the 24 rats was removed. Results: There were no significant differences between the groups in mean SLM durations on days one through five. No significant differences were detected in the pathological examination between of the four groups. Conclusion: Future studies that employ biochemical markers and free radical levels in the brain are needed.
The Effects of Proanthocyanidin on Vasospasm After Experimental Subarachnoidal Hemorrhage in Rats
(2018) Yilmaz, Cem; Cansever, Tufan; Kırceli, Atilla; Ozen, Ozlem Isiksacam; Aydemir, Fatih; Akar, Aykan; Caner, Hakan; 30192366
AIM: Delayed ischemic neurological deficit (DIND) and cerebral vasospasm (CV) remain the most common and debilitating neurological complications following aneurysmal subarachnoidal hemorrhage (SAH). Many reports demonstrate the importance of proanthocyanidins (PR) on the vascular system, including endothelium-dependent relaxation of blood vessels. These effects of PR on the cerebral vascular system were examined in this study. MATERIAL and METHODS: Fifty-two adult Sprague-Dawley male rats were used for the experimental double hemorrhage model. They were divided to control, sham, pre- and post-interventional treatment groups. 100 mg/kg PR was administered for the treatment for respect to groups. Basilar artery diameter (BAD) and arterial wall thickness were measured and the apoptosis ratio of the endothelial cells was calculated. Arterial walls were examined electron microscopically (EM). RESULTS: There were significant differences between the groups except control and pre-SAH (p=0.37) and post-SAH and preSAH groups (p=0.15) with respect to BAD. According to arterial wall thickness, apoptosis ratio, and grading, there were significant differences between the groups except control and pre-SAH (p=0.85, p=0.49 and p=0.18 respectively) and SAH and post-SAH (p=0.08, p=0.21 and p=0.24 respectively) groups. EM findings revealed that pro-apoptotic and pro-necrotic degenerated endothelial cells with seldom vacuolization in post-SAH treatment group which were more serious in SAH group. CONCLUSION: Pre-SAH administration of PR induces better vasodilatation and protection of basilar artery (BA) from vasospasm (VS), which could yield neuroprotective and vasodilatator effects. In addition, PR appears to be involved in relieving oxidative damage, with an antioxidant-antiapoptotic-antinecrotic effect that may contribute to vascular dilation.
Endovascular Treatment of Wide Necked Ruptured Saccular Aneurysms with Flow-Diverter Stent
(2017) Duman, Enes; Coven, Ilker; Yildirim, Erkan; Yilmaz, Cem; Pinar, H.Ulas; 0000-0002-2353-8044; 0000-0003-0473-6763; 0000-0002-9057-722X; 27593785; AAK-2948-2021; Q-2420-2015; ABI-3856-2020
AIM: Flow diverter (FD) stents have been used in the treatment of unruptured intracranial aneurysms. There are a few studies that report the use of these devices in ruptured blister-like aneurysms. We present 5 consecutive patients, who had ruptured intracranial wide necked or side branch close to the neck of saccular aneurysms, with no other treatment options, treated with FD stents and coil embolization. MATERIAL and METHODS: Between September 2012 and April 2015, 139 ruptured aneurysms of 133 consequent patients were treated. Of these, 48 were surgically treated aneurysms. Five of the remaining 85 aneurysms treated with FD stents. Three aneurysms were in the posterior communicating artery, and 2 were in the supraclinoid internal carotid artery (ICA). Partial coil embolization was performed in addition to FD stents in three patients. All patients were treated in the first 3 days after bleeding. RESULTS: Technical success was 100%. Inappropriate deployment of silk stent and partial thrombus formation occurred in one patient due to the jailed micro-catheter. Inappropriate apposition of stent was corrected with a balloon, and the thrombus resolved with tirofiban, tissue plasminogen activator (t-PA) injections. No other complication or death occurred related to the procedure. One patient who had a giant ICA aneurysm and Fisher grade 4 bleeding died due to vasospasm, cerebral edema and sepsis on the postoperative 13th day. The other patients were followed-up uneventfully with computed tomography angiography (CTA) at 6th month and digital subtraction angiography (DSA) at 12th month. CONCLUSION: FD stents can be used in the treatment of ruptured large wide necked or side branch close to the neck of saccular aneurysms when other treatment options can not be used.
Herpes Zoster Brachial Plexopathy: Direct Steroid Injection
(2017) Araz, Coskun; Askin, Suna; Yilmaz, Cem; 0000-0002-2353-8044; 0000-0002-4927-6660; 27560523; AAK-2948-2021; AAJ-4576-2021
Herpes zoster (shingles) is a viral disease, characterized by painful skin eruptions and neuropathic sensory symptoms. Motor involvement and brachial plexus involvement in herpes zoster are rare conditions. Together with antiviral medication and pain therapy, palliative and supportive modalities take an important role in the treatment of herpes zoster. It is well documented in previous reports that oral or intravenous steroid administrations may be additive in management. In this case report, positive effects of direct steroid injection onto the brachial plexus via ultrasonography guidance in a patient with motor weakness due to herpes zoster involvement of brachial plexus is presented.
The influence of adjunctive caudal epidural steroid injection on the therapeutic effect of transforaminal epidural steroid injection
(2018) Kircelli, Atilla; Cansever, Tufan; Yilmaz, Cem; 0000-0002-2353-8044; 0000-0003-2109-1274; 29322966; AAK-2948-2021
Background: Epidural steroid injection is widely used to treat the short and long-term symptoms of low back and radicular pain. To the best of our knowledge, the influence of transforaminal epidural steroid injection (TFSI) combined with caudal epidural steroid injection (CESI) on pain intensity, patient satisfaction, and quality of life in lumbar radiculopathy has not been examined. Aim: To evaluate the short and long-term efficacy of TFSI, and TFSI combined with CESI (TFSI + CESI) in patients with lumbar radiculopathy. Materials and Methods: We retrospectively examined the records of 104 patients with lumbar radicular pain and L4/5 and/or L5/S1 intervertebral disc disease who underwent TFSI or TFSI + CESI. We compared the pain intensity using a Visual Numeric Scale (VNS), North American Spine Society (NASS) pain satisfaction index, and EuroQol five dimensions (EQ-5D) quality of life scores before intervention, and after 1, 6 and 12 months. Results: In the TFSI group, the mean pre-treatment VNS score was 9.2, which improved to 4.9 after 1 month and to 7.2 after 12 months. In the TFSI + CESI group, the mean pre-treatment VNS score was 9.4, which improved to 2.6 and 4.6 after 1 and 12 months, respectively. Improvement in the VNS scores was significantly higher in the TFSI + CESI group (P < 0.0001 for each). Mean EQ-5D quality of life index in the TFSI group improved from 0.59 in the pre-treatment phase to 0.76 after 12 months of intervention, while it improved from 0.62 in the pre-treatment phase to 0.84 at 12 months of intervention in the TFSI + CESI group. The EQ-5D scores were significantly better in the TFSI + CESI group at 1, 6, and 12 months after the procedure (P = 0.004, 0.036, and 0.042, for 1, 6, and 12 months, respectively). The NASS scores were significantly better in the TFSI + CESI group at 6 and 12 months after the intervention (P = 0.025 and 0.001 for 6 months and 12 months, respectively). Conclusion: In patients with lower lumbar radiculopathy, a combined TFSI + CESI technique offers superior short and long-term pain relief, quality of life, and long-term patient satisfaction, than when TFSI is performed alone.
The Influence of Percutaneous Vertebral Augmentation Techniques on Recompression in Patients with Osteoporotic Vertebral Compression Fractures. Percutaneous Vertebroplasty versus Balloon Kyphoplasty
(2023) Sahinturk, Fikret; Sonmez, Erkin; Ayhan, Selim; Gulsen, Salih; Yilmaz, Cem; 0000-0002-5693-3542; 0000-0002-2353-8044; 0000-0002-0471-3177; 37257650; AAJ-5746-2021; AAI-8820-2021; AAK-2948-2021; AAI-7972-2021
-OBJECTIVE: The purpose of this study was to determine whether percutaneous vertebroplasty (PVP) and balloon kyphoplasty (BK) have any mid-term to long-term effects on the structural integrity of augmented vertebrae.-METHODS: According to our hospital records, 351 patients underwent BK and PVP as a result of osteoporotic vertebral compression fractures between 2010 and 2020. The demographic, surgical, and radiologic characteristics of the patients were analyzed retrospectively using the electronic hospital records and PACS (picture archiving and communication system). In our study, 55 patients who had a single level of PVP or BK filled with at least 6 mL og polymethylmethacrylate (PMMA) for T11-L5 levels and 3 mL of PMMA for T6-T10 levels via a bipedicular approach and who had only 1 vertebral fracture in a 10-year follow-up period were included in our study. The patients were divided into 2 groups: BK (n = 40) and PVP (n = 15). All measurements were performed on standing lateral radiographs from the postoperative first day and the last radiographs that were obtained during the follow-up. The anterior and posterior heights of the fractured vertebral body and local kyphosis angles were measured.-RESULTS: The mean follow-up time was 2.53 & PLUSMN; 1.78 years in the BK group and 3.07 & PLUSMN; 2.02 years in the PVP group. The decrease in the vertebral height and increasing kyphosis that develop from the early to late postoperative periods were found to be statistically significant in the BK group (P < 0.05). In the PVP group, vertebral height and kyphosis angle measurements did not differ significantly between the early and late postoperative periods. In addition, in terms of the percentage change, anterior parts of the vertebral bodies are more affected. However, the absolute difference for the measurement of the vertebral heights did not confirm this finding.-CONCLUSIONS: To our knowledge, our study is unique because it has the longest follow-up in the literature comparing BK and PVP in terms of recollapse of the augmented vertebrae. Our study shows that BK does not prevent height loss of the augmented vertebral bodies in the mid-to long term.
Letter: Sacroplasty Augmentation of Instrumented Pelvic Reconstruction After High Sacrectomy: A Technical Case Report
(2022) Sahinturk, Fikret; Ayhan, Selim; Sonmez, Erkin; Gulsen, Salih; Yilmaz, Cem; https://orcid.org/0000-0002-0471-3177; https://orcid.org/0000-0003-0153-3012; 34982931; AAI-7972-2021; U-5409-2018; IYT-2145-2023
Lumbosacral Conjoined Root Anomaly: Anatomical Considerations of Exiting Angles and Root Thickness
(2017) Kircelli, Atilla; Can, Halil; Kavadar, Gulis; Civelek, Erdinc; Cansever, Tufan; Aydoseli, Aydin; Onal, Mehmet Bulent; Yilmaz, Cem; 0000-0003-2109-1274; 27593795
AIM: Conjoined nerve roots (CNR) can be damaged during lumbar disc surgery and lead to neuropathic pain due to excessive retraction. The purpose of this study was to investigate the factors that facilitate the identification of CNRs that can lead to the loss of fragments in the secondary axilla, nerve root injury or unpleasant surprises during lumbar disc surgery. Accordingly, we aimed to measure the thicknesses and exit angles of the nerve roots close to the pedicle to obtain scientific data regarding rare double roots. MATERIAL and METHODS: The data of 612 patients who were operated for lumbar disc disease in our hospital between 2012 and 2014 were reviewed retrospectively. Twenty one cases of CNR were detected in this series. RESULTS: The mean nerve root thickness was 1.92 0.45 mm for medially located roots and 3.33 +/- 0.95 mm for laterally located roots. The comparison of medially located roots versus laterally located roots revealed a significant difference in mean values (p<0.0001). The mean exit angle was 12.29 degrees +/- 4.89 degrees for medially located roots, and 22.11 degrees +/- 5.42 degrees for laterally located roots (p<0.0001). In addition, the exit angles of the medially and laterally located roots increased as going down to caudal levels, (p=0.005, p=0.042). CONCLUSION: CNRs are congenital anomalies that are usually diagnosed during the surgical procedure and affect the success of discectomy. The presence of a more medially located or thinner root during surgical exploration and the absence of the fragment in the axilla in extruded or sequestered discs usually indicate a conjoined nerve root closer to the pedicle.
Neuronal regeneration in injured rat spinal cord after human dental pulp derived neural crest stem cell transplantation
(2018) Kircelli, Ali; Yilmaz, Cem; Kabatas, S.; Demir, C.S.; Civelek, E.; Yilmaz, I.; Akyuva, Y.; Karaoz, E.; 0000-0003-2109-1274; 29536742
OBJECTIVE: This study aimed to analyze the effect of human Dental Pulp-Neural Crest Stem Cells (hDP-NCSCs) delivery on lesion site after spinal cord injury (SCI), and to observe the functional recovery after transplantation. METHODS: Neural Crest Stem Cells (NCSCs) were isolated from human Dental Pulp (hDP). The experimental rat population was divided into four groups (n = 6/24). Their behavioral motility was scored regularly. After 4-weeks, rats were sacrificed, and their spinal cords were examined for Green Fluorescent Protein (GFP) labeled hDP-NCSCs by immunofluorescence (IF) staining. RESULTS: In early post-injury (p.i) period, the ultrastructure of spinal cord tissue was preserved in Group 4. The majority of cells forming the ependymal region around the central canal were found to be hDP-NCSCs. While the grey-and-white-matter around the ependymal region was composed of e.g. GFP cells, with astrocytic-like appearance. The scores showed significant motor recovery in hind limb functions in Group 4. However, no obvious change was observed in other groups. C ONCLUSION: Cells e.g., mesenchymal (Vimentin+) which express GFP+ cells in the gray-and-white-matter around the ependymal region could indicate the potential to self-renewal and plasticity. Thus, transplantation of hDP-NCSCs might be an effective strategy to improve functional recovery following spinal cord trauma (Fig. 10, Ref. 32). Text in PDF www.elis.sk.
Patient Selection and Efficacy of Intradiscal Electrothermal Therapy with Respect to the Dallas Discogram Score
(2017) Kircelli, Atilla; Coven, Ilker; Cansever, Tufan; Sonmez, Erkin; Yilmaz, Cem; 0000-0002-2353-8044; 0000-0002-5693-3542; 0000-0003-2109-1274; 27593796; AAK-2948-2021; AAI-8820-2021
AIM: Intervertebral disc degeneration can cause severe low back pain. Intradiscal electrothermal therapy (IDET) is a minimally invasive treatment option for patients with symptomatic internal disc disruption unresponsive to conservative medical care. We aimed to evaluate 12-month pain and functional outcomes and predictors of clinical success in patients with discogenic back pain treated with IDET with respect to the Dallas Discogram Scale (DDS). MATERIAL and METHODS: This was a retrospective analysis of patients undergoing IDET for low back pain from 2009 through 2014 at Baskent University, Department of Neurosurgery. A total number of 120 consecutive patients data were collected retrospectively. The degree of disc degeneration was graded using the DDS during discography, and the presence of a high intensity zone (HIZ) on magnetic resonance (MR) imaging was noted. The primary outcome measure was assessment of back pain severity based on the Visual Analogue Scale (VAS); function was assessed by the Oswestry Disability Index (ODI). Follow-up examinations for ODI and VAS scores were assessed at 1, 6, and 12 months post-treatment. Outcomes were discussed with respect to morphological changes in intervertebral discs on discogram. RESULTS: There was an average 57.39% and 47.16% improvement in VAS and ODI scores, respectively, between pretreatment and 12 months follow-up (p<0.0001 for both comparisons). Predictors of 12-month clinical success was depended on DDS (p< 0.0001), a HIZ on MR imaging (p<0.0001). CONCLUSION: Durable clinical improvements can be realized after IDET in select surgical candidates with mild disc degeneration and HIZ, discography, and low-grade DDS, with more effective treatment results.
The Retrospective Analysis of the Effect of Balloon Kyphoplasty to the Adjacent-segment Fracture in 171 Patients
(2014) Civelek, Erdinc; Cansever, Tufan; Yilmaz, Cem; Kabatas, Serdar; Gulsen, Salih; Aydemir, Fatih; Altnors, Nur; Caner, Hakan; https://orcid.org/0000-0002-3988-4064; https://orcid.org/0000-0002-2353-8044; https://orcid.org/0000-0003-2691-6861; https://orcid.org/0000-0002-7535-1804; https://orcid.org/0000-0002-3400-9025; 24795949; ABI-6105-2020; AAK-2948-2021; AAA-3069-2020; AAJ-5746-2021
Study Design: Analysis of the adjacent-segment fractures in 171 balloon kyphoplasty (BK)-performed patients. Objective: The purpose of this study was to investigate the risk factors for new symptomatic vertebral compression fractures (VCF) after BK. Summary of Background Data: Although there are many studies about the incidence and possible risk factors for occurrence of adjacent-level fractures, there is no consensus on the increased risk of adjacent-level fractures after BK. Methods: We performed a retrospective analysis of 171 patients treated with percutaneous kyphoplasty. The follow-up period was 41.04 +/- 21.78 months. The occurrence of new symptomatic VCF was recorded after the procedure. We evaluated the variables of patient age and sex, the amount of injected cement, the initial kyphotic angle (KA) of VCF, the change of the KA after BK, the severity of osteoporosis, and the percentage of height restoration of the vertebral body. Furthermore, possible risk factors were reported for new symptomatic VCFs. Results: The only 2 factors identified as being significantly associated with adjacent-level fractures were the sex (P=0.001) of the patient and the preoperative KA (P=0.013). The patients with new symptomatic compression fracture had higher initial KA than those without fractures. The female group had higher risk than the male group in occurrence of the new vertebra fractures. The severity of the osteoporosis (low bone mineral density) was not a determinant in occurrence of the new VCF after BK. Conclusions: If the patients experience severe or mild back pain with higher preoperative KA, especially in the first 2 months, then they deserve detailed radiologic examination. To avoid subsequent fracture in the same or adjacent level, vertebral body should be filled adequately and sagittal balance should be obtained with KA correction. BK alone did not influence the incidence of subsequent VCF.
Spontaneous Spinal Subarachnoid Hemorrhage with Residual Arachnoid Cyst: A Case Report
(2017) Derle, Eda; Iyigundogdu, Ilkin; Yilmaz, Cem; 0000-0003-2122-1016; 0000-0001-7860-040X; 0000-0002-2353-8044; 27593750; AAI-8830-2021; AAJ-2053-2021; AAK-2948-2021
Spinal subarachnoid hemorrhage is a rare condition that usually occurs because of secondary causes and idiopathic spontaneous ones are extremely rare. We report a 56-year-old woman who presented with severe headache, neck pain and urinary retention. Magnetic resonance imaging revealed subarachnoid hemorrhage that extended from T1 to lumbar vertebrae. She was treated conservatively and symptoms were resolved within 1 month. An asymptomatic arachnoid cyst was observed on the follow-up magnetic resonance imaging after 3 months with no neurologic deterioration. She was still stable clinically and radiologically at the end of 19 months. Spinal subarachnoid hemorrhage is a surgical emergency, although in some cases a conservative approach may be useful.
Stereotaxic Biopsy Experience
(2020) Dere, Umit Akin; Sahinturk, Fikret; Sonmez, Erkin; Gulsen, Salih; Yilmaz, Cem; Altinors, Mehmet Nur
Aim: To review the outcomes and complications of stereotactic biopsy procedures performed at Neurosurgery Department of Baskent University and make an overall evaluation of the stereotactic biopsy system. Materials and Methods: Medical files of 151 patients who underwent stereotaxic biopsy procedure between 1996 and 2018 were retrospectively analyzed.The , age and gender of the patients, intracranial localization of the lesion and histopathologic diagnosis were evaluated. Result: The series included 84(55.6%) males and 67 (44.4%) females. The average age was 47.7 and the age spectrum was between 26-84 years of age. In 102 cases (67.55%) lesions had lobar localization and in 42 lesions (27.82%) the pathology was deep seated lesion. In 7(4.6 %) there were multiple lesions. A histopathologic diagnosis was obtained in 125 (82.79 %) cases. In 16 (%10.59 %) it was reported as brain tissue and in 10 cases (6.62 %) the histopathologic diagnosis was gliosis. A second stereotactic bipsy procedure was performed in 8 cases while in one patient a third biopsy became necessary. Thirteen patients underwent craniotomy and tumor excision as further therapy. Conclusion: Stereotactic biopsy sampling of intracranial space occupying lesions is a safe, simple and highly diagnostic method. In some cases it may contribute to further therapy. The problems encountered are inconclusive diagnosis, inadequate representation of the specimen due to its limited nature and some technical difficulties.
Turkish Board of Neurological Surgery
(2019) Bulduk, Erkut Baha; Yilmaz, Cem; 30614509
AIM: To provide information on the process and the results of the Turkish Board of Neurological Surgery and increase the relevant awareness. MATERIAL and METHODS: The number of applications to the written and oral board exams organized by the Turkish Neurosurgical Society Proficiency Board since 2006, the number of successful and unsuccessful participants, and the number of the neurosurgery residents and specialists who applied to the exam were evaluated. RESULTS: A total of 554 candidates took the exam since 2006 when the first TBNS was applied. Two hundred and sixty of the candidates were successful (46.9%), and 294 (53.1%) were unsuccessful. Two hundred and forty six (44.4%) of those who took the test were neurosurgeons, 308 (55.6%) were neurosurgery residents who had completed their 3rd year in their training. The highest score in the written exams was 93/100, and the lowest score was 33/100. In verbal exams, a total of 73 candidates participated, and 66 (90.4%) of them were successful while 7 of them (9.6%) were unsuccessful. CONCLUSION: Board exams are inevitable to provide a certain level of education and standardization in the training of neurosurgery. Our duty as neurosurgeons is to participate in these exams and work to increase participation for continuing education.