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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.Item Turkish Board of Neurological Surgery(2019) Bulduk, Erkut Baha; Yilmaz, Cem; 30614509AIM: 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.Item 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, HakanObjective: 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.Item Biphasic Pulmonary Blastoma Associated with Cerebral Metastasis(2016) Kilic, Dalokay; Yilmaz, Cem; Tepeoglu, Merih; Vural, Cigdem; Caner, Hakan; 26768884Pulmonary 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.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 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-4576-2021Herpes 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.Item 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-8820-2021AIM: 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.Item 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; 27593795AIM: 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.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.