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Öğe Cerebellitis and Concomitant Acute Hydrocephalus in a Child: Case Report(2014) Erdi, Fatih; Emiroğlu, Melike; Kaya, Bülent; Karataş, Yaşar; Güney, ÖnderAcute cerebellitis is a severe neurological disease characterized by mild or high-grade fever, nystagmus, tremor, truncal ataxia, dysarthria, headache, and altered mental state. The diagnose can be established on the basis of clinical symptoms, radiological imaging and laboratory findings. Acute life threatening hydrocephalus can be seen as a complication of acute cerebellitis associated with obstruction at the level of the fourth ventricle. Neurosurgical procedures as a life-saving intervention can be required which range from external ventricular drainage to ventricular peritoneal shunt and posterior fossa decompression. In this report we present a case of cerebellitis and concomitant acute hydrocephalus in a child which was treated succesfully with external ventricular drainage and medical treatment and also discuss the main features of this rare but important concomitance.Öğe Congenital Carotid-Jugular Fistula in a Child A Case Report(Sage Publications Inc, 2014) Erdi, Fatih; Kaya, Bulent; Keskin, Fatih; Koc, Osman; Karatas, Yasar; Kalkan, ErdalCongenital carotid-jugular (CJ) fistula of the neck is a very rare clinical entity that has various causes. The CJ fistulas are particularly prone to complications unlike other peripheral arteriovenous fistulas. The aim of this report is to present a case of a CJ fistula between the external carotid and the external jugular vein, which was successfully closed with detachable balloon by an endovascular approach. A 14-year-old child was admitted to our clinic with a pulsatile neck swelling. There was no previous history of trauma. A high-flow fistula between the external carotid and the external jugular vein was determined. The fistula was closed with detachable balloon by an endovascular approach. The postoperative angiogram demonstrated complete resolution of the fistula. Endovascular treatment of CJ fistulas with detachable balloons is a safe and less traumatic technique and may be an effective alternative to the open surgery in selected patients.Öğe The effects of steroids in traumatic thoracolumbar junction patients on neurological outcome(Turkish Assoc Trauma Emergency Surgery, 2019) Ilik, Mustafa Kemal; Keskin, Fatih; Erdi, Fatih; Kaya, Bulent; Karatas, Yasar; Kalkan, ErdalBACKGROUND: In this study, we aim to evaluate the potential effects of methylprednisolone on the neurological outcome of spinal cord injury (SCI) patients with thoracolumbar junction (T10-L1) spine fractures. METHODS: The data from 182 SCI patients who sustained a thoracolumbar junction spine fracture were operated by us between September 2008 to January 2015 were analysed retrospectively. The patients were divided into two groups: Group I underwent methylprednisolone treatment in conjunction with early surgical intervention, while group 2 underwent only early surgical intervention without methylprednisolone treatment. American Spinal Injury Association (ASIA) motor index scores of the patients were evaluated and compared with statistical methods at admission and at the first-year follow-up. RESULTS:The main follow-up period was 14.4 +/- 1.4 months in group 1 and 13.6 +/- 1.7 months in group 2. Initial and last follow-up ASIA scores of the patients were similar between groups (p>0.05), but the complication rate was significantly high in group 1 (p<0.05). CONCULSION: The findings showed that steroids have no significant beneficial effects on the neurological outcome but have significant side effects and leads to increased complication rate in SCI patients.Öğe Endoscopic Endonasal Transethmoidal Approach for the Management of a Traumatic Brain Abscess and Reconstruction of the Accompanying Anterior Skull Base Defect(Lippincott Williams & Wilkins, 2015) Tanriover, Necmettin; Kucukyuruk, Baris; Erdi, Fatih; Kafadar, Ali Metin; Gazioglu, NurperiSkull base endoscopy in the treatment of brain abscesses has been rarely published. Moreover, endoscopic endonasal transethmoidal approach (EETA) for the treatment of brain abscess following a head trauma has been reported only in a few case reports. We report the management of a patient of intracerebral abscess and reconstruction of the accompanying anterior skull base defect through an EETA.Thirty-year-old male with a frontal lobe abscess due to a penetrating skull base trauma was operated via EETA. After drainage of the abscess, dural and bony defects were repaired to prevent any recurrence. Postoperative radiological imaging revealed prominent decrease in abscess size. The patient did not need any further surgical intervention, and antibiotherapy was adequate.EETA is safe and effective in the management of brain abscesses. Skull base endoscopy provides direct visualization of the abscess cavity through a minimal invasive route, facilitates wide exposure of surrounding neurovascular structures within the operative field, and enables concurrent closure of the skull base defect.Öğe Endovascular management of a collateral network aneurysm in a patient with spontaneous internal carotid artery occlusion(Sage Publications Inc, 2015) Kaya, Bulent; Erdi, Fatih; Keskin, Fatih; Kalkan, Erdal; Koc, OsmanSpontaneous non-moyamoya'' arterial occlusion of the intracranial arteries is very unusual. Progressive occlusion of a major intracranial artery, independently from the etiology, can lead to the development of collateral arterial networks that supply blood flow to distal territories beyond the occlusion. These collateral arteries are typically small and conduct low flows, but the hemodynamic stress within them can lead to aneurysm formation within the collateral network. In this report we present a case of spontaneous internal carotid artery occlusion and collateral network aneurysm for the first time in the literature and discuss the main features of the etiology and endovascular treatment of this rare, challenging aneurysm.Öğe Endovascular treatment of complex intracranial aneurysms by pipeline flow-diverter embolization device: a single-center experience(Maney Publishing, 2015) Keskin, Fatih; Erdi, Fatih; Kaya, Bulent; Poyraz, Necdet; Keskin, Suat; Kalkan, Erdal; Ozbek, OrhanObjective: Endovascular coil embolization has become an effective treatment modality for most intracranial aneurysms. However, complex aneurysms including large and giant aneurysms, fusiform shaped aneurysms, wide necked aneurysm, or small aneurysm that are unsuitable for coil embolization are still deterrent to be treated. Flow diversion is a novel concept that is applied in the treatment of these complex intracranial aneurysms. Method: We review the results and important features of 25 aneurysms in 24 patients who underwent endovascular treatment by using the pipeline flow-diverter embolization device. Result: At 6 month follow-up, all aneurysms (100%) showed total occlusion in our series. Only one patient who had giant vertebrobasilar aneurysm experienced major complication related to endovascular treatment. Discussion: We suggest that parent artery reconstruction via flow diversion with the PED is a valid and safe treatment modality.Öğe Evaluation of nosocomial infections and related risk factors in a neurosurgery intensive care unit(E-Century Publishing Corp, 2016) Erayman, Ibrahim; Erdi, Fatih; Kalkan, Erdal; Karatas, Yasar; Kaya, Bulent; Keskin, Fatih; Izci, Emir K.Nosocomial infections (NIs) cause increased morbidity, mortality, and hospital costs, particularly in intensive care units. Neurosurgery intensive care units (NICUs) differ from other intensive care units in several respects. The aim of this study was to examine NIs and related risk factors in our NICU. NICU records and the database of our hospital's infection control team from January 2010 to December 2014 were reviewed retrospectively. Type of NI and associated risk factors were subjected to statistical analysis. Demographic data, risk factors for NI development, presentation, length of NICU stay, and Glasgow Coma Scale (GCS) score were recorded and reviewed. One hundred and eighteen NI episodes were detected in 115 of 820 patients. The mean age of the patient population was 42.4 years (range 16-74 years). Of the infected patients, 55 were female and 60 were male. The mean length of hospital stay of these patients was 38.4 +/- 21.8 days. The most common type of NI was ventilator-associated pneumonia, and the most frequently detected pathogen was Acinetobacter spp. GCS score, prior usage of broad-spectrum antibiotics, reoperation, mechanical ventilation, external lumbar or ventricular drainage, tracheostomy, and duration of NICU stay were significantly higher among infected patients. Univariate analysis identified low GCS score, longer NICU stay, use of mechanical ventilation, prior usage of broad-spectrum antibiotics, and reoperation as risk factors for NI.Öğe Facilitating triple rhomboid flaps for meningomyelocele defect closure using a honeycomb structure as a template(Springer, 2016) Karacor-Altuntas, Zeynep; Dadaci, Mehmet; Erdi, Fatih; Ince, Bilsev; Uyar, Ilker; Yarar, SerhatPurpose Various reconstruction options are available for the soft-tissue coverage of meningomyelocele defects. For small defects, primary closure or local single flaps may be sufficient, while large defects require more complex reconstructive techniques. This study suggests an easy way for surgeons to close large meningomyelocele defects using triple rhomboid flaps. Methods The hexagonal structure of a honeycomb was considered when planning for the coverage of large meningomyelocele defects. The intact skin around the defect was imagined as multiple hexagons, which allowed us to plan triple rhomboid flaps correctly and more easily. This technique was used in seven patients with defects ranging from 7 x 5 to 12 x 8 cm in size. Results No major postoperative complications were seen. Minimal dehiscence was observed in two patients and healed secondarily. Conclusions The honeycomb modification for planning triple rhomboid flaps is an easy, practical, and memorable approach for surgeons reconstructing large meningomyelocele defects.Öğe High thioredoxin reductase 1 expression in meningiomas undergoing malignant progression(Springer Japan Kk, 2015) Esen, Hasan; Feyzioglu, Bahadir; Erdi, Fatih; Keskin, Fatih; Kaya, Bulent; Demir, Lutfi SaltukThioredoxin (Trx) is a redox active protein that regulates several physiological and biochemical functions, such as growth, apoptosis and cellular defense. The function of Trx itself is regulated by thioredoxin reductase (TrxR). This study was designed to determine the expression of TrxR1 in meningioma tissues of different World Health Organization grades (grade I-III). Meningioma tissues were extracted from the histopathological specimens of 29 patients. These samples included seven histologically normal meningeal tissues that served as a control group and 12 grade I, 12 grade II and 5 grade III meningioma samples. TrxR1 expression was evaluated using quantitative reverse transcription polymerase chain reaction (qRT-PCR) and immunostaining. The proliferative and apoptotic indices of the specimens were investigated by Ki-67 immunostaining and TUNEL assay, respectively. TrxR1 expression, as assessed by qRT-PCR, increased significantly with meningioma grade (p < 0.001). The immunostaining intensity of TrxR1 increased significantly with meningioma grade (p < 0.001). Ki-67 index values increased significantly in accordance with grade progression (p < 0.001). The apoptotic index values were not significantly different in any group (p > 0.05). Trx system seems to be involved in the malignant progression of meningiomas. Further, large studies are required to elucidate the exact role of this system.Öğe Hydrothorax Development after Ventriculopleural Shunt in a Patient with Peritoneum Absorption Dysfunction(Cukurova Univ, Fac Medicine, 2014) Kalkan, Erdal; Ilik, Mustafa Kemal; Erdi, Fatih; Kaya, BulentAlthough hydrocephaly has been recognized for years, its treatment and follow-up remain obscure. Ventriculoperitoneal shunt application is the most common treatment used in recent years. However, revision incidence and mortality are very high due to infection, overdrainage or underdrainage, and obstruction. 62 years old female patient was operated and ventriculopleural shunt performed in our clinic. Fifth day after operation persistant dyspneic complaints exists. Chest graphia performed and bilateral pleural effusion was seen. In this report, we present a case of hydrothorax after ventriculopleural shunt operation. Ventriculopleural shunting was preferred in this patient because peritoneal absorption disorder developed after recurrent ventriculoperitoneal shunt operations and revisions. The tension hydrothorax that developed is discussed in light of the relevant literature.Öğe Increased expression of ubiquitin C-terminal hydrolase L1 in astrocytomas of ascending grades(Lippincott Williams & Wilkins, 2023) Izci, Emir Kaan; Keskin, Fatih; Erdi, Fatih; Kaya, Bulent; Karatas, Yasar; Feyzioglu, Bahadir; Findik, SiddikaBackground:The ubiquitin-proteasome pathway controls the monitoring and degradation of important proteins and is involved in several cellular processes, such as development, differentiation, and transcriptional regulation. Recent evidence has shown that ubiquitin carboxy-terminal hydrolase-L1 (UCH-L1), a member of the deubiquitinating enzyme family that removes ubiquitin from protein substrates, is overexpressed in many types of cancer. Aim:This study thus examined the expression of UCH-L1 in human astrocytoma tissues. Material and methods:Formalin-fixed, paraffin-embedded astrocytoma samples were obtained from 40 patients, after which histopathological examination, typing, and grading were performed. The study group included 10 histologically normal brain tissues, which served as the control group, and 10 WHO grade II, 10 WHO grade III, and 10 WHO grade IV (glioblastoma) samples. Normal brain tissue samples were obtained from the histologically normal, non-tumoral portion of the pathology specimens. UCH-L1 expression was evaluated using quantitative reverse transcription-polymerase chain reaction and immunohistochemistry. Results:Astrocytoma tissues exhibited higher UCH-L1 expression compared to the control group. UCH-L1 overexpression increased significantly together with the increase in astrocytoma grades (from II to IV). Conclusion:UCH-L1 could be a good diagnostic and therapeutic marker for determining astrocytoma development and progression.Öğe Intratumoral hemorrhage-related differences in the expression of vascular endothelial growth factor, basic fibroblast growth factor and thioredoxin reductase 1 in human glioblastoma(Spandidos Publ Ltd, 2016) Kaya, Bulent; Cicek, Onur; Erdi, Fatih; Findik, Siddika; Karatas, Yasar; Esen, Hasan; Keskin, FatihThe present study was designed to evaluate the expression of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and thioredoxin reductase 1 (TrxR1) in glioblastoma multiforme (GBM) with and without intratumoral hemorrhage. Surgically resected human GBM samples from 20 patients who underwent surgery at our institute were extracted from the histopathological specimens and divided into two groups. A total of 10 samples from each type of GBM (World Health Organization grade IV, intratumoral hemorrhage-positive or -negative) were included in each group. VEGF, bFGF and TrxR1 expression was analyzed using immunohistochemistry and the results were compared between groups. VEGF and bFGF immunoreactivity was significantly higher in GBMs containing intratumoral hemorrhage. Furthermore, VEGF, bFGF and TrxR1 immunointensity was significantly higher in GBMs containing intratumoral hemorrhage. Thus, the present study demonstrated a higher VEGF, bFGF and TrxR1 expression in GBMs contain intratumoral hemorrhage, indicatiogn a role of VEGF, bFGF and TrxR1 expression in the promotion of tumoral angiogenesis and tumoral growth by complex mechanisms that require further elucidation.Öğe Isolated Dural and Calvarial Metastasis in a patient with Breast Carcinoma: A Case Report(2015) Kaya, Bülent; Erdi, Fatih; Keskin, Mehmet Fatih; Karataş, Yaşar; İzci, Emir Kaan; Toğuşlu, GökhanLiteratürde malign neoplazmların dural metastazları ile ilgili az bilgi bulunmaktadır. Kesin etyopatogenezleri ve tedavi stratejileri tartışmalıdır. Dura matere en sık metastaz meme kanserinden olmaktadır. 41 yaşında bayan hasta kliniğimize baş ağrısı ve sol parietalde şişlik şikayeti ile başvurdu. Hasta 3 yıl önce infiltratif duktal kanser nedeni ile opere edilmişti. Sol kalvaryal ve dura metastazı tespit edildi ve sol pariyetal kraniotomi ile cerrahi rezeksiyon uygulandı. Hasta operasyondan sonra tüm beyin radyoterapi aldı. Bu yazıda kafatası ve duraya metastaz yapan bir kanser vakasını ve bu nadir hastalığın ana özelliklerini tartıştık.Öğe Multiple Lumbar Perineural Cysts Presented with Nonspecific Back Pain(2013) Kaya, Bülent; Kalkan, Erdal; Erdi, Fatih; Keskin, Fatih; Karataş, YaşarBu yazıda oldukça nadir görülen çoklu lomber perinöral kist olgusu sunulmuştur. Talov kistleri olarak da bilinen perinöral kistler genellikle sakral bölge yerleşimlidirler. Çoklu lomber perinöral kistler oldukça nadir görülürler. 50 yaşındaki erkek hasta nonspesifik bel ağrısı şikayeti ile kliniğimize başvurdu.Nörolojik muayenesi normal sınırlarda idi. Manyetik rezonans görüntülemede lomber bölgede multipl perinöral kist saptandı. Hastaya herhangi bir cerrahi müdahale olmadan tıbbi tedavi uygulandı. Hasta medikal tedaviden oldukça yarar gördü. Multipl lomber perinöral kistlerin nörolojik bulgu vermeden görülmeleri oldukça nadir olmasına rağmen tedavi stratejileri konusunda tartışmalar devam etmektedir.Öğe New Clues in the Malignant Progression of Glioblastoma: Can the Thioredoxin System Play a Role?(2018) Erdi, Fatih; Kaya, Bülent; Esen, Hasan; Karataş, Yaşar; Fındık, Sıddıka; Keskin, Fatih; Feyzioğlu, Bahadır; Kalkan, ErdalAIm: To evaluate and compare the expression of thioredoxin reductase 1 (TrxR1) in primary and secondary glioblastoma samples. mATERIAl and mEThODS: Surgically resected human glioblastoma samples from 40 patients who underwent surgery at our institution were extracted from their histopathological specimens and divided into three groups. Ten histopathologically regular cerebral tissue samples, acquired from the non-neoplastic portion of the specimens, were assigned as the control group. Twenty specimens that included tumoral tissue from each type of glioblastoma (WHO grade IV, primary and secondary) were assigned as the primary and secondary glioblastoma groups. TrxR1 expression was analyzed by using both quantitative reverse transcription polymerase chain reaction (qRT-PCR) and immunohistochemistry. Isocitrate dehydrogenase 1 (IDH1) mutation was analyzed by immunohistochemistry. Ki-67 proliferative index and apoptosis were also analyzed by immunohistochemistry. The differences between the groups were statistically compared and the correlation between these parameters was analyzed. RESulTS: The expressions of TrxR1 and Ki-67 values were significantly higher in primary glioblastoma. IDH1 mutation was significantly higher in secondary glioblastoma. TrxR1 expression was found to be highly correlated with the Ki-67 index. The apoptotic index was similar between primary and secondary glioblastoma. CONCluSION: This study showed a high TrxR1 expression in primary glioblastoma which could indicate a role of the Trx system in promoting the malignant progression by some complex processes.Öğe Radiological anatomy of the C7 vertebra: Clinical implications in spine surgery(Wolters Kluwer Medknow Publications, 2015) Keskin, Fatih; Erdi, Fatih; Nayman, Alaaddin; Babaoglu, Ozan; Erdal, Kalkan; Ozer, Ali FahirContext: This study was designed to understand and define the special radio-anatomic morphometry of C7 vertebra by using multidetector computed tomography (MDCT). Aims: The major aim of the study was to detect the gender- and side-related morphometric differences of C7 vertebra among subjects. Setting and design: Our radiology unit database scanned for MDCT sections of the C7 vertebra. Materials and Methods: A total of 214 patients (134 men, 80 women) were selected. A detailed morphometric evaluation of C7 was done. Statistical analysis used: T test, ANOVA. Lamina length (P < 0.001), pedicle length (P < 0.001), outer cortical (P = 0.01) and inner cancellous pedicle (P < 0.001) width, pedicle angle to sagittal plane (P < 0.001) values were statistically significantly different on the right versus left side. When the results were stratified by gender, lamina length, inner cancellous lamina height, pedicle length, inner cancellous pedicle height, outer cortical pedicle width, lateral mass anteroposterior length, anteroposterior length of C7 corpus, height of C7 corpus (P < 0.001), C6-7 (P = 0.013) and C7-T1disc height (P = 0.04), transverse foramina perpendicular width at C7 (P = 0.046) values were found to be statistically significantly different. Vertebral artery most commonly enters into the transverse foramina at C6 level. Conclusions: Gender and side differences are important factors for preoperative planning and showed significant differences among subjects. MDCT is a practical option for investigating the exact anatomical features of osseous structures.Öğe The Role of Fenestration of the Lamina Terminalis on Symptomatic Vasospasm After Aneurysmal Subarachnoid Hemorrhage: A Clinical Research(2016) Cengiz, Şahika Liva; Ilık, Mustafa Kemal; Erdi, Fatih; Üstün, Mehmet ErkanAIM: To compare the beneficial effects of cisternal blood clot evacuation with or without microsurgical fenestration of the lamina terminalis (LT) on symptomatic vasospasm during the course of aneurysmal subarachnoid hemorrhage. MATERIAL and METhODS: This was a clinical, retrospective study that included 72 patients with aneurysmal subarachnoid hemorrhage (aSAH). The patient group that underwent aneurysm clipping with only extensive cisternal drainage of the subarachnoid blood clot was defined as the non fenestrated lamina terminalis group (NonFLT group, n39). The patient group that underwent aneurysm clipping with extensive cisternal drainage of the subarachnoid blood clot combined with microsurgical fenestration of LT was defined as the fenestrated lamina terminalis group (FLT group, n33). All patients were operated by the same experienced neurovascular surgeon, the senior author of this article (MEU), and his colleagues. New cerebral infarct development was determined with computed tomography, Glasgow Outcome Score (GOS), clinical vasospasm rate and Hunt-Hess scale (H&H) grade before and after surgery and duration of hospital stay of the patients were assessed and compared. RESULTS: A favorable clinical outcome was obtained from 51.2% of the NonFLT group patients and 72.66% of the FLT group patients. And FLT group patients have better GOS and H&H grade. Clinical vasospasm rate and duration of hospital stay were also significantly reduced in FLT group patients. CONCLUSION: Wide fenestration of lamina terminalis as a cerebrospinal fluid diversion technique may be very beneficial in the surgical treatment of aneurysmal SAH.Öğe Ruptured spinal artery aneurysm associated with coarctation of the aorta(Elsevier Science Inc, 2016) Erdi, Fatih; Keskin, Fatih; Kalkan, Havva; Karatas, Yasar; Koc, Osman[Abstract Not Availabe]Öğe Sellar-Suprasellar Extraventricular Choroid Plexus Papilloma : A Case Report and Review of the Literature(Korean Neurosurgical Soc, 2016) Keskin, Fatih; Erdi, Fatih; Kaya, Bulent; Toy, HaticeChoroid plexus papillomas (CPPs) are relatively rare neuroectodermal tumors that develop from choroid plexus epithelial cells and are usually restricted to the ventricles. Extraventricular CPPs are very unusual and can be difficult to diagnose and treat. A 50-year-old male patient was admitted to our clinic complaining of headache and visual deterioration. Neurological examination found no abnormalities except decreased light perception and secondary optic atrophy in the left eye. Endocrine testing revealed normal levels of hormones produced by the pituitary and target glands. Magnetic resonance imaging of the brain revealed a huge regular-shaped lesion in the sellar-suprasellar region occupying the sella turcica and extending into the suprasellar cistern and planum sphenoidale. The lesion was completely excised by microsurgery via an ordinary left-sided pterional approach. Histopathology identified the lesion as a choroid plexus papilloma. Following the case report, literature on the origin, differential diagnosis, and treatment of this rare tumor is reviewed.Öğe The Surgical Management of Traumatic C6-C7 Spondyloptosis(Korean Neurosurgical Soc, 2013) Keskin, Fatih; Kalkan, Erdal; Erdi, FatihA case of traumatic spondyloptosis of the cervical spine at the C6-C7 level is reported. The patient was treated succesfully with a anterior-posterior combined approach and decompression. The patient had good neurological outcome after surgery. A-51-year-old female patient was transported to our hospital's emergency department after a vehicle accident. The patient was quadriparetic (Asia D, MRC power 4/5) with severe neck pain. Plain radiographs, computerize tomography and spinal magnetic resonance imaging (MRI) showed C6-7 spondyloptosis and C5, C6 posterior element fractures. Gardner-Wells skeleton traction was applied. Spinal alignment was reachived by traction and dislocation was decreased to a grade 1 spondylolisthesis. Then the patient was firstly operated by anterior approach. Anterior stabilization and fusion was firstly achieved. Seven days after first operation the patient was operated by a posterior approach. The posterior stabilization and fusion was achieved. Postoperative lateral X-rays and three-dimensional computed tomography showed the physiological realignment and the correct screw placements. The patient's quadriparesis was improved significantly. Subaxial cervical spondyloptosis is a relatively rare clinical entity. In this report we present a summary of the clinical presentation, the surgical technique and outcome of this rarely seen spinal disorder.
