Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item 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.Item 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-2145-2023Item Aneurysmal Bone Cyst in a Renal Transplant Patient(2022) Sahinturk, Fikret; Sonmez, Erkin; Altinors, Nur; Terzi, Aysen; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0002-0471-3177; 31324137; AAJ-8097-2021; AAI-7972-2021Aneurysmal bone cysts constitute 1% to 2% of all primary bone tumors. They are rapidly growing benign bone tumors. Nearly 80% of aneurysmal bone cysts occur in the first 20 years of life, and most are primary tumors. Aneurysmal bone cysts are mostly benign, locally aggressive, and highly vascularized tumors. Generally, the period required for postoperative recovery and new bone formation is long. The relapse rate can be up to 50%. Although computed tomography and magnetic resonance imaging scans are the preferred diagnostic methods, biopsy is the most necessary prerequisite to confirm diagnosis, as aspects of these cysts can show similarity to many other bone lesions. Correct histopathologic diagnosis is important since malignancies may be seen in transplant recipients.Item Vertebral Body Lipoma An Unusual Pathology Treated With Kyphoplasty(2018) Sahinturk, Fikret; Dere, Umit Akin; Sonmez, Erkin; Altinors, Nur; Terzi, Aysen; 0000-0002-0471-3177; 0000-0002-6678-6224; 0000-0002-5693-3542; 0000-0002-1225-1320; 30226833; AAI-7972-2021; N-1435-2014; AAI-8820-2021; F-7546-2013Study Design. Case report. Objective. This case report is unique since this is the first vertebral lipom case that was treated by kyphoplasty alone. Summary of Background Data. Vertebral lipoma is extremely rare and our search of the English literature has revealed 20 patients in 16 reports. Methods. A 32-year-old female patient was admitted to our neurosurgery department with the chief complaint of low back pain that had lasted nearly 1 year. A lumbar MR suggested a hemangioma and the patient was operated on. Results. On microscopic examination, the lesion was seen to have a widely infiltrating appearance of mature fat tissue between bone trabeculae diagnosis was intraosseous lipoma. Conclusion. We believe that the management should be surgical total removal of the lesion even in incidentally found cases in order to obtain histologic diagnosis and pain relief.Item Intracranial Fungal Infection After Solid-Organ Transplant(2018) Sahinturk, Fikret; Demirkaya, Hamiyet; Dere, Umit Akin; Sonmez, Erkin; Altinors, Nur; Moray, Gokhan; Haberal, Mehmet; 0000-0002-0471-3177; 0000-0002-6678-6224; 0000-0002-5693-3542; 0000-0003-2498-7287; 0000-0002-3462-7632; 29528023; AAI-7972-2021; N-1435-2014; AAI-8820-2021; AAE-1041-2021; AAJ-8097-2021Neurologic complications after solid-organ transplant reveal a great spectrum of pathologies. Intracranial hemorrhages, cerebral ischemic lesions, infarctions, lymphoproliferative disorders, and infections, including aspergillosis, have been observed after liver transplant. Fungi constitute nearly 5% of all central nervous system infections, mainly occurring in immunocompromised patients. The most common causative agent is Aspergillus species. It presents either as maxillary sinusitis or pulmonary infection. Brain involvement of Aspergillus carries a high rate of mortality. Aspergillosis presents in the forms of meningitis, mycotic aneurysms, infarctions, and mass lesions. Aspergillosis does not have a specific radiologic appearance. Parenchymal aspergillosis has heterogenous signal intensity (hypointense on T1-weighted and hyperintense on T2-weighted images). Here, we present 3 patients who underwent solid-organ transplant and developed central nervous system aspergillosis. Different modalities of neurosurgical intervention were performed in combination with chemotherapy as part of their fungal therapy.Item The Global Spine Care Initiative: A Systematic Review For The Assessment of Spine-Related Complaints in Populations With Limited Resources and in Low- and Middle-Income Communities(2018) Nordin, Margareta; Randhawa, Kristi; Torres, Paola; Yu, Hainan; Haldeman, Scott; Brady, O'Dane; Cote, Pierre; Torres, Carlos; Modic, Michael; Mullerpatan, Rajani; Cedraschi, Christine; Chou, Roger; Acaroglu, Emre; Hurwitz, Eric L.; Lemeunier, Nadege; Dudler, Jean; Taylor-Vaisey, Anne; Sonmez, Erkin; https://orcid.org/0000-0002-5693-3542; 29492717; AAI-8820-2021Purpose The purpose of this systematic literature review was to develop recommendations for the assessment of spine-related complaints in medically underserved areas with limited resources. Methods We conducted a systematic review and best evidence synthesis of guidelines on the assessment of spine-related complaints. Independent reviewers critically appraised eligible guidelines using the Appraisal of Guidelines for Research and Evaluation-II criteria. Low risk of bias clinical practice guidelines was used to develop recommendations. In accordance with the mandate of the Global Spinal Care Initiative (GSCI), recommendations were selected that could be applied to medically underserved areas and low- and middle-income countries by considering the limited access and costs of diagnostic technologies. Results We screened 3069 citations; 20 guidelines were eligible for critical appraisal. We used 13 that had a low risk of bias that targeted neck and back pain. Conclusions When assessing patients with spine-related complaints in medically underserved areas and low- and middle-income countries, we recommend that clinicians should: (1) take a clinical history to determine signs or symptoms suggesting serious pathology (red flags) and psychological factors (yellow flags); (2) perform a physical examination (musculoskeletal and neurological); (3) do not routinely obtain diagnostic imaging; (4) obtain diagnostic imaging and/or laboratory tests when serious pathologies are suspected, and/or presence of progressive neurologic deficits, and/or disabling persistent pain; (5) do not perform electromyography or nerve conduction studies for diagnosis of intervertebral disc disease with radiculopathy; and (6) do not perform discography for the assessment of spinal disorders. This information can be used to inform the GSCI care pathway and model of care.Item The Global Spine Care Initiative: World Spine Care Executive Summary on Reducing Spine-Related Disability in Low- And Middle-Income Communities(2018) Sonmez, Erkin; https://orcid.org/0000-0002-5693-3542; 30151809; AAI-8820-2021Purpose Spinal disorders, including back and neck pain, are major causes of disability, economic hardship, and morbidity, especially in underserved communities and low- and middle-income countries. Currently, there is no model of care to address this issue. This paper provides an overview of the papers from the Global Spine Care Initiative (GSCI), which was convened to develop an evidence-based, practical, and sustainable, spinal healthcare model for communities around the world with various levels of resources. Methods Leading spine clinicians and scientists around the world were invited to participate. The interprofessional, international team consisted of 68 members from 24 countries, representing most disciplines that study or care for patients with spinal symptoms, including family physicians, spine surgeons, rheumatologists, chiropractors, physical therapists, epidemiologists, research methodologists, and other stakeholders. Results Literature reviews on the burden of spinal disorders and six categories of evidence-based interventions for spinal disorders (assessment, public health, psychosocial, noninvasive, invasive, and the management of osteoporosis) were completed. In addition, participants developed a stratification system for surgical intervention, a classification system for spinal disorders, an evidence-based care pathway, and lists of resources and recommendations to implement the GSCI model of care. Conclusion The GSCI proposes an evidence-based model that is consistent with recent calls for action to reduce the global burden of spinal disorders. The model requires testing to determine feasibility. If it proves to be implementable, this model holds great promise to reduce the tremendous global burden of spinal disorders.Item Cervical Spinal Ependymoma With Hemorrhage in a Renal Transplant Patient(2022) Sahinturk, Fikret; Dere, Umit Akin; Kirnap, Mahir; Sonmez, Erkin; Altinors, Nur; Ozen, Ozlem; Haberal, Mehmet; https://orcid.org/0000-0002-0471-3177; https://orcid.org/0000-0002-6678-6224; 30251937; AAI-7972-2021; N-1435-2014Ependymomas are the most common intramedullary spinal tumors in adults and constitute around 20% of all spinal tumors in adults. There are 3 subgroups of ependymomas according to World Health Organization classification: subependymoma or myxopapillary (grade 1), ependymoma (grade 2), and anaplastic (grade 3). Therapy for patients is aimed at safe and total surgical removal and, in selected cases, postoperative radiotherapy. Bleeding from a spinal ependymoma, with subsequent urgent surgery, is extremely rare. Here, we present a case of a renal transplant patient who had a cervical ependymoma. Although a considerable volume of peritumoral blood was observed during surgery, the patient had no neurologic deficits and no signs of deterioration.Item 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-2948-2021Objectives: 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.Item Stereotaxic Biopsy Experience(2020) Dere, Umit Akin; Sahinturk, Fikret; Sonmez, Erkin; Gulsen, Salih; Yilmaz, Cem; Altinors, Mehmet NurAim: 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.