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Öğe Bir çocukta serebellumun disembriyoplastik nöroepiteliyal tümörü(2014) Köse, Doğan; Kalkan, Erdal; Paksoy, Yahya; Toy, Hatice; Üçüncü Ergün, Nurcan; Köksal, YavuzDisembriyoplastik nöroepitelyial tümörler (DNT) tipik olarak supratentorial yerleşen benign neoplazmalardır. Bilinç ve postural tonus kaybı şikayetleri ile bir lokal hastaneye başvuran 12 yaşındaki erkek hasta saptanan serebellar kitlesi nedeniyle hastanemize refere edildi. Hikayesinden benzer şikayetlerinin 3 ve 10 yaşlarında da tekrar ettiği ancak o dönemde pediatric kardiyolog ve pediatric nörolog tarafından yapılan incelemelerde herhangi bir anomaliye rastlanmadığı öğrenildi. Hastanın fizik muayenesi ve rutin laboratuvar tetkikleri normaldi. Serebellumda saptanan kitle total olarak çıkarıldı. Alınan dokunun histopatolojik değerlendirmesi ile hastaya DNT tanısı konuldu. Hasta halen, 5 yıldır, herhangi bir nüks belirtisi olmadan ayaktan takip edilmektedir. Bu yazıda serebellum yerleşimli DNT'ye sahip bir çocuk vakanın literatürle paylaşılması amaçlanmıştır.Öğe A Case of Upper Thoracic Intradural-Extramedullary Multiple Meningiomas(Lippincott Williams & Wilkins, 2013) Keskin, Fatih; Kalkan, Erdal; Karatas, YasarIntradural spinal tumors are classified into extramedullary and intramedullary tumors. The most frequent intradural-extramedullary tumors are meningiomas and neurinomas. Meningiomas mostly occur in thoracic region and are generally located at the dorsal aspect. Multiplicity is a rare condition for spinal meningiomas, and multiple spinal meningiomas are usually associated with neurofibromatosis. In this report, we present a case of thoracic spinal multiple meningiomas which was located at the ventral aspect and not associated with neurofibromatosis.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 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 An Experimental Study: Does the Neuroprotective Effect Increase When Hypothermia Deepens After Traumatic Brain Injury?(Kowsar Publ, 2015) Girisgin, Abdullah Sadik; Kalkan, Erdal; Ergin, Mehmet; Keskin, Fatih; Dundar, Zerrin Defne; Kebapcioglu, Sedat; Kocak, SedatBackground: Experimental approaches have been promising with the use of therapeutic hypothermia after Traumatic Brain Injury (TBI) whereas clinical data have not supported its efficacy. Objectives: This study aimed to investigate whether using selective deeper brain cooling correlates with a more neuroprotective effect on Intracranial Pressure (ICP) increments following TBI in rats. Materials and Methods: Adult male Sprague-Dawley rats (mean weight = 300 g; n = 25) were subjected to brain injury using a modified Marmarou method. Immediately after the onset of TBI, rats were randomized into three groups. Selective brain cooling was applied around the head using ice packages. Intracranial Temperature (ICT) and ICP were continuously measured at 0, 30, 60, 120, and 180 minutes and recorded for all groups. Group 1 (n = 5) was normothermia and was assigned as the control group. Group 2 (n = 10) received moderate hypothermia with a target ICT of between 32 degrees C-33 degrees C and Group 3 (n = 10) was given a deeper hypothermia with a target ICT of below 32 degrees C. Results: All subjects reached the target ICT by the 30th minute of hypothermia induction. The ICT was significantly different in Group 2 compared to Group 1 only at the 120th minute (P = 0.017), while ICP was significantly lower starting from the 30th minute (P = 0.015). The ICT was significantly lower in Group 3 compared to Groups 1 and 2 starting from the 30th minute (P = 0.001 and P = 0.003, respectively). The ICP was significantly lower in Group 3 compared to Group 1 starting from 30th minute (P = 0.001); however, a significant difference in ICP between Group 3 and Group 2 was observed only at the 180th minute (P = 0.047). Conclusions: Results of this study indicate that selective brain cooling is an effective method of decreasing ICP in rats; however, the deeper hypothermia caused a greater decrease in ICP three hours after hypothermia induction.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 Multiple Cerebral Aneurysms and Subacute-Subdural Hematoma Coexistence With Multiple Meningiomas: A Case Report(Lippincott Williams & Wilkins, 2013) Keskin, Fatih; Kalkan, Erdal; Erdi, Mehmet F.Multiple aneurysms and multiple meningiomas coexistance can be seen rarely. Subarachnoid hemorrhage and subacute subdural hematoma coexistance in the same case is very rare. The female patient, at the age of 52, was hospitalized through emergency service with temporary blackout and severe headache complaints. There were no signs of trauma seen during her physical examination. Neck stiffness was positive. The patient's Glasgow Coma Scale score was 15. Right frontoparietal subacute subdural hematoma and subarachnoid hemorrhage were determined with computerized brain tomography. Contrast enhanced magnetic resonance imaging showed two lesions which were sized 1.5x0.5 cm and 2.5x2.0 cm in the left occipital lobe. Bilateral middle cerebral artery (MCA) bifurcation aneuryms were determined at cerebral angiography. Bilateral MCA bifurcation aneurysm clippage and total excision of both tumoral lesions were done in the same operation with bilateral pterional and left occipital craniotomy. Pathological investigation of the tumoral lesions were reported as meningioma. The postoperative stage was uneventful. The patient's neurological examination was intact without any neurological deficit. Multiple cerebral aneurysms and multiple meningiomas coexistance can be seen rarely in the course of some connective tissue diseases and neurofibromatosis. In this report we present a case of multiple aneurysms and meningiomas without connective tissue disease or neurofibromatosis. The patient was treated succesfully by different surgical approaches in the same session.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 Periton Absorbsiyon Bozukluğu Olan Bir Hastada Ventriküloplevral Şant Operasyonu Sonrasında Gelişen Hidrotoraks(2014) Kalkan, Erdal; İlik, Mustafa Kemal; Erdi, Mehmet Fatih; Kaya, BülentHidrosefali yıllardan beri bilinen bir hastalık olmasına rağmen takip ve tedavisinde halen bilinmeyen noktalar bulunmaktadır.Hidrosefali tedavisinde alen ventriküloperitoneal şant cerrahisi en sık kullanılan tedavi yöntermidir. Ancak revizyon insidansı ve mortalitesi; enfeksiyon, fazla/az drenaj tıkanma nedeniyle oldukça yüksektir. 62 yaşında bayan hasta kliniğimizde opere edilerek ventriküloplevral şant uygulandı. Ameliyat sonrası beşinci günde hastada ilerleyici tipte nefes darlığı ve siyanoz şikayetleri ortaya çıktı. Hastanın çekilen akciğer grafisinde solda plevral effüzyon tespit edildi. Ventriküloplevral şant cerrahisi rekürren ventriküloperitoneal şant operasyonları ve revizyonları sonrası görülebilen peritoneal absorbsiyon bozuklukları nedeniyle tercih edilmektedir. Bu raporda ventriküloplevral şant sonrası gelişen tansiyon hidrotorakslı bir olgu sunulmuş ve literatür eşliğinde tartışılmıştır.Öğe Primary tumor of thoracic vertebra: chondrosarcoma(Elsevier Science Inc, 2016) Keskin, Fatih; Kalkan, Havva; Kaciran, Burkay K.; Erdi, M. Fatih; Karatas, Yasar; Kalkan, Erdal[Abstract Not Availabe]Öğe Supratentoryal ve infratentoryal yerleşimli multiple kavernom olgusu(2013) Kalkan, Erdal; Keskin, Fatih; Karataş, Yaşar; Kaya, Bülent; Güney, Ahmed ÖnderSerebral kavernöz hemanjiomlar vasküler yapıların nadir görülen malformasyonlarındandır. Sporadik formda lezyonlar genellikle tek iken, lezyonların multipl olması daha çok familyal tipte rastlanılan bir durumdur. Semptomatik hastalar başağrısı, epileptik nöbet, fokal nörolojik defisit, hemoraji veya bunların kombinasyonu ile hastaneye başvururlar. Bizim olgumuz multiple supratentoryal lezyonların yanı sıra infratentoryal tutulumun da birlikte görülmesi ve multiple kavernom olmasına rağmen herediter geçişli olmaması nedeniyle literatürdeki sunumlardan farklılık göstermektedir.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.
