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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 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 Morphometric Analysis of the Sacral Canal and Hiatus Using Multidetector Computed Tomography for Interventional Procedures(Turkish Neurosurgical Soc, 2015) Kilicaslan, Alper; Keskin, Fatih; Babaoglu, Ozan; Gok, Funda; Erdi, Mehmet Fatih; Kaya, Bulent; Ozbiner, HuseyinAIM:The sacral canal has been frequently used asa passagefor minimally invasive diagnostic and therapeutic procedures for spinal diseases. The aim of the present study was to investigate morphometric analyses of the sacral canal, hiatus, and surrounding structures according to different age groups and gender by using themultidetector computed tomography method. MATERIAL and METHODS: Multiplanar-reconstructed images from 300 adult (150 females and 150 males, between 20 and 80 years old) were divided into three groups according to age and retrospectively examined. Various anatomic measurements of the sacral hiatus, surrounding structures, and sacral canal were performed. Sacral curvature angle and lumbosacral lordotic angle were noted. RESULTS: Bony anatomic abnormalities such as absent hiatus (0.3%), complete agenesis (1%), and bony septum (2.6%) were detected in some cases. The anteroposterior (AP) diameter of the hiatus was less than 2 mm in 5% of cases. In all groups, the mean values of the hiatus AP diameter and area, and the shortest distance of the sacral canal AP diameter were shorter in the 60-80 years age group when compared with those in 20-39 years age group (p=0.01). The shortest sacral canal AP diameter was commonly located at the S2 and S3 levels in 59.2% and 33.9% of cases, respectively. The levels of maximum curvature were at S3 and S2 in 63.3% and 26.7% of cases, respectively. Median sacral curvature angles and lumbosacral lordotic angles were measured as 164 degrees and 134 degrees, respectively. CONCLUSION: Sacral structures have morphometric variations. Understanding of the detailed anatomy may improve the reliability of interventional procedures.Öğe Neuroprotective Effects of Tocilizumab on Experimentally-Induced Spinal Cord Ischemia-Reperfusion Injury(Elsevier Science Inc, 2019) Karatas, Yasar; Erdi, Mehmet Fatih; Kaya, Bulent; Keskin, Fatih; Cuce, Gokhan; Kilinc, Ibrahim; Uyar, MehmetOBJECTIVES: We aimed to evaluate neuroprotective effects of tocilizumab on spinal cord ischemia-reperfusion (I/R) injury. Our study design was an experimental rabbit spinal cord I/R injury model, and the setting was at the Animal Research Laboratory, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey. METHODS: Twenty-four adult New Zealand rabbits were randomly divided into 3 groups: Group 1, control group (n = 8); Group 2, I/R group, and Group 3 (n = 8) I/R injury D tocilizumab (4 mg/kg, ip) treatment group. Spinal cord I/R injury repair was performed by infrarenal aortic cross clamping. On neurologic evaluation, spinal cord tissue plasma tumor necrosis factor alpha (TNFa), total antioxidant status (TAS), total oxidant status (TOS), thiobarbituric acid reactive substances (TBARS), interleukin 6 (IL-6), interleukin 10 (IL-10) levels were analyzed. Spinal cord neuronal damage score and apoptotic cell count were also investigated. RESULTS: I/R injury significantly increases the plasma and spinal cord tissue TNFa, TOS, TBARS, and IL-6 levels and decreases the plasma and spinal cord tissue TAS and IL-10 levels. Tocilizumab treatment significantly reduces the plasma and spinal cord tissue TNF alpha, TOS, TBARS, IL-6 levels and increases plasma and tissue TAS and IL-10 levels. I/R injury significantly increases spinal cord neuronal damage score and apoptotic cell count. Tocilizumab treatment significantly reduces spinal cord neuronal damage score and apoptotic cell count. Neurologic examination scores at 24, 48, and 72 hours were significantly better in the treatment group when compared with the I/R group. CONCLUSIONS: This study shows significant neuroprotective effects of tocilizumab on rabbit spinal cord I/R injury.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 Telmisartan ameliorates oxidative stress and subarachnoid haemorrhage-induced cerebral vasospasm(Taylor & Francis Ltd, 2016) Erdi, Fatih; Keskin, Fatih; Esen, Hasan; Kaya, Bulent; Feyzioglu, Bahadir; Kilinc, Ibrahim; Karatas, YasarObjectives: Growing evidence suggests that oxidative stress is one of the factors contributing to subarachnoid haemorrhage (SAH)-induced cerebral vasospasm. SAH-induced cerebral vasospam alters thioredoxin (Trx) cycle enzymes and thioredoxin-interacting protein (TXNIP) as an important endogenous antioxidant system. In this study, we have explored the effects of telmisartan on the vascular morphological changes, endothelial apoptosis, tissue oxidative stress status and the level of Trx cycle enzymes/TXNIP in a rabbit SAH model. Methods: Forty male New Zealand rabbits were randomly divided into five groups of eight rabbits each: control group, sham group, SAH group, SAH + vehicle group and SAH + telmisartan group. SAH was created by a single cisterna magna blood injection. SAH + telmisartan group received telmisartan treatment (5 mg/kg intraperitoneal, once daily) for 72 h. The brainstem tissue Trx1, Trx2, Trx reductase (TrxR), TrxR1and TXNIP levels were investigated. Total oxidant status (TOS), total antioxidant status (TAS), malondialdehyde (MDA) levels and tumour necrosis factor alpha (TNF alpha) levels were investigated. Basilar artery segments were investigated for cross-sectional area, wall thickness measurements and endothelial apoptosis. Results: Telmisartan treatment restored the lowered level of Trx1, TrxR, TAS and the expression of TrxR1 seen in SAH. Telmisartan treatment also decreased TXNIP expression, TOS, MDA and TNF alpha levels. Morphological changes of cerebral vasospasm were attenuated after treatment. Endothelial apoptosis significantly reduced. Discussion: Treatment with telmisartan ameliorates oxidative stress and SAH-induced cerebral vasospasm in rabbits. These effects of telmisartan may be associated with downregulation of TXNIP and upregulation of Trx/TrxR.Öğe Tissue thioredoxin reductase-1 expression in astrocytomas of different grades(Springer, 2015) Esen, Hasan; Erdi, Fatih; Kaya, Bulent; Feyzioglu, Bahadir; Keskin, Fatih; 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). Studies performed in a variety of human primary tumors have shown that thioredoxin reductase 1 (TrxR1) is overexpressed in tumoral tissues compared with corresponding normal tissues. This study was designed to determine the expression of TrxR1 in astrocytoma tissues of different World Health Organization (WHO) grades (grade I-IV). The proliferative (Ki-67) and apoptotic indices of the specimens were also investigated for correlation analysis. Astrocytoma tissues were extracted from the histopathological specimens of 40 patients. These samples included seven histologically normal brain tissues that served as a control group and ten tumoral samples for each grade of astrocytoma (grade I-IV). The histologically normal brain tissues were obtained from the non-tumoral portions of the pathological specimens of grade I (2 cases), grade II (2 cases), grade III (2 cases) and grade IV (1 case) astrocytomas. 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 astrocytoma grade (p = 0.01). The immunostaining intensity of TrxR1 in grade IV astrocytomas was significantly greater than that in the control tissue and all other astrocytoma grades (p < 0.001). Similarly, immunostaining intensity of TrxR1 in the grade III astrocytomas was significantly greater than that in the control group and grade I astrocytomas (p < 0.001). All astrocytoma tissues showed more intense staining in ascending grades, but the differences between grade I and the control, grade II and the control, grades II and I, grades III and II were not statistically significant (p > 0.05). Ki-67 index values increased significant in accordance with grade progression (p = 0.01). The apoptotic index values were not significantly different in any group (p > 0.05); however, the differences between grade IV and the control and between grades IV and I were statistically significant (p < 0.05). Expression of TrxR1, as assessed by both qRT-PCR and immunostaining, correlated highly with both the astrocytoma grade and Ki-67 index.
