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Item Effects of the Cerebral Aneurysm Treatment Method on Coil Packing Density and Its Relationship with the Ostium Area(2022) Kesim, Cagri; Ozcan, Umit Can; Yildirim, Erkan; https://orcid.org/0000-0002-8964-291X; https://orcid.org/0000-0002-4447-0296; 35283278; AAD-5996-2021; AAM-3467-2021Purpose: To test the following hypotheses: (a) balloon or stent assistance increases coil packing density (CPD) in the endovascular treatment of intracranial aneurysms, and (b) CPD correlates to ostium area (OA) and aneurysm volume (AV). Materials and Methods: This retrospective study included 60 aneurysms (54 ruptured and 6 unruptured) treated with simple coiling (SC) (n = 18), balloon-assisted coiling (BAC) (n = 7), or stent-assisted coiling (SAC) (n = 35) at the authors' institution between August 2017 and December 2019. AV and OA measurements were obtained from 3-dimensional digital subtraction angiography images using commercial software. Coil sizes were retrieved from patient files, and coil volume (CV) measurements were obtained from https://www.angiocalc.com/. Analysis of covariance, multivariate covariance analysis, and Pearson correlation analyses were performed. Results: The median value for AV, CV, CPD, and OA was 63.4 mm(3) (range, 5.5-1,771.4 mm(3)), 23.13 mm(3) (range, 2.03-296.95 mm(3)), 33.29% (range, 13.41%-81.02%), and 10.7 mm(2) (range, 2.7-49.9 mm(2)), respectively. Multivariate analysis showed that the CPD values were not significantly different among the treatment groups, although OA significantly differed between the SC and SAC groups (P <.05). Pearson correlations showed that similar to AV, OA was negatively correlated with CPD (r = -0.321, P <.05). Conclusions: The CPD value in cerebral aneurysms treated with BAC or SAC did not differ from that in aneurysms treated with SC.Item The importance of craniovertebral and cervicomedullary angles in cervicogenic headache(2014) Coban, Goken; Coven, Ilker; Cifci, Bilal Egemen; Yildirim, Erkan; Yazici, Ayse Canan; Horasanli, BahriyePURPOSE Many studies have indicated that cervicogenic headache may originate from the cervical structures innervated by the upper cervical spinal nerves. To date, no study has investigated whether narrowing of the craniovertebral angle (CVA) or cervicomedullary angle (CMA) affects the three upper cervical spinal nerves. The aim of this study was to investigate the effect of CVA and/or CMA narrowing on the occurrence of cervicogenic headache. MATERIALS AND METHODS Two hundred and five patients diagnosed with cervicogenic headache were included in the study. The pain scores of patients were determined using a visual analog scale. The nonheadache control group consisted of 40 volunteers. CVA and CMA values were measured on sagittal T2-weighted magnetic resonance imaging (MRI), on two occasions by two radiologists. Angle values and categorized pain scores were compared statistically between the groups. RESULTS Intraobserver and interobserver agreement was over 97% for all measurements. Pain scores increased with decreasing CVA and CMA values. Mean angle values were significantly different among the pain categories (P < 0.001). The pain score was negatively correlated with CMA (Spearman correlation coefficient, r(s), -0.676; P < 0.001) and CVA values (r(s), -0.725; P < 0.001). CONCLUSION CVA or CMA narrowing affects the occurrence of cervicogenic headache. There is an inverse relationship between the angle values and pain scores.Item Effect of Topical Tetracycline on Seroma Formation in the Lichtenstein Technique: A Prospective Randomized Study(2014) Turk, Emin; Karagulle, Erdal; Coban, Gokcen; Yildirim, Erkan; Moray, GokhanWe sought to investigate whether application of topical tetracycline has a limiting effect on seroma formation in patients undergoing hernia repair using a polypropylene mesh. This study was conducted in 96 patients undergoing an elective groin hernia repair. Patients were randomized and divided into 2 groups. After the graft was placed, and before external oblique muscle aponeurosis was closed, 5 mL tetracycline was administered on the graft in the tetracycline group (tetra group, n = 50), and 5 mL isotonic saline was administered in the control group (n = 46) without putting in a drain. Seroma checks via surface ultrasonography were done. Seroma amounts measured on the first day were significantly higher in the tetra group (P = 0.04). There were no significant differences regarding seroma measurements on the seventh day or in the first and second months. Topical tetracycline application has no limiting effect on seroma formation after a groin hernia operation.Item Balloon Dilatation of Iatrogenic Ureteral Strictures after Upper Urinary Tract Reconstruction(2015) Duman, Enes; Yildirim, Erkan; Akillioglu, Ishak; Yucesan, SelcukPurpose: Open pyeloplasty is the gold standard treatment of uretero-pelvic junction (UPJ) stenosis. Although failure after open pyeloplasty or uretero-neosistosmy is not common, percutaneous or endoscopic interventions must be necessary in some cases. We present treatment of 6 pediatric patients by balloon dilatation after failed surgery. Material and Methods: Between 2008 and 2013 6 children were treated. Five patients had undergone open pyeloplasty for UP stenosis and, one has uretero-vesical anastomosis stricture after ureteroneosistostomy. Percutaneous antegrade balloon dilatation and double J stent placement were performed in three of six patients. In the other three patients retrograde endoscopic balloon dilatation and double J stent placement were performed. Results: Primary technical success was %50 and %100 for antegrade and retrograde approach respectively. Antegrade approach has failed in 3 patients (%50) and, retrograde approach and treatment were successful in all of these patients. Secondary and tertiary balloon dilatations were done through antegrade approach in 3 patients. Mean duration of double J stent was 114 days. As of today, five patients are followed smoothly. One patient who has UP stenosis underwent secondary open surgery. Conclusion: Balloon dilatation can be used safely in both antegrade and retrograde approaches because of lower profile of balloon catheters, so it could be considered as a first line treatment option after failed surgical treatment of upper urinary tract stenosis in children.Item Association between treatment with coil embolization of renal artery aneurysm and resistant hypertension(2016) Duman, Enes; Yildirim, Erkan; Ciftci, Ozgur; Cifci, EgemenHypertension is the number one risk factor in preventable causes of death in the world. Resistant hypertension is defined as blood pressure that remains uncontrolled despite at least three antihypertensive medications including a diuretic. Treatment of hypertension includes many modalities from lifestyle changing to multiple drug using, angioplasty. In this case report, we aim to emphasize the effects of renal artery aneurysm treatment on resistant hypertension.Item Percutaneous Placement of Pancreatico-biliary Drainage Catheter for the Treatment of Complicated Pancreatic Anastomotic Leakage: an Alternative Treatment Option(2016) Duman, Enes; Yildirim, Erkan; 0000-0002-9057-722X; 27994344; ABI-3856-2020A 58-year-old female patient who had anastomotic leakage after a Whipple operation was treated with a percutaneously placed pancreatico-biliary drainage catheter. Complete secondary healing of the anastomotic defect and leakage was seen on control cholangiography examination on the 35th postoperative day, and the pancreatico-biliary drainage catheter was removed. She was discharged on the 39th postoperative day uneventfully. Percutaneous pancreatico-biliary drainage should be kept in mind as an alternative treatment option of complicated pancreatic anastomotic leakage after a Whipple operation.Item Epileptic Seizures Induced by a Spontaneous Carotid Cavernous Fistula(2016) Celik, Guner Koyuncu; Yildirim, Erkan; 0000-0002-9057-722X; 0000-0002-2477-3660; 28077946; ABI-3856-2020A 79-year-old woman was admitted to our emergency department with complaints of fainting and loss of consciousness three times during the past month. She was diagnosed with epilepsy and started to be treated with antiepileptic drug. Physical examination showed, in the left eye, chemosis, limited eye movements in all directions, and minimal exophthalmos as unexisting symptoms on admission developed on the sixth day. Orbital magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) imaging revealed a carotid cavernous fistula (CCF). Epileptic attacks and ophthalmic findings previously present but diagnosed during our examinations were determined to ameliorate completely after performing the coil embolization. Based on literature, we present the first case with nontraumatic CCF manifesting with epileptic seizures and intermittent eye symptoms in the present report.Item 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-3856-2020AIM: 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.Item 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-2948-2021AIM: 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.Item Cerebrovascular Events Secondary to Pulmonary Arteriovenous Malformation Based on Genetic Heterogeneity(2017) Yildirim, Erkan; Celik, Guner; Yurdakul, Huseyin; 29033646