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    Does Gross Total Resection Improve Progression-Free and Overall Survival in Pediatric Intracranial Ependymomas? Single-Center Clinical Experience Of 61 Cases
    (Elsevier Science Inc, 2022) Narin, Firat; Bahadir, Sinan; Hanalioglu, Sahin; Karakaya, Dicle; Basar, Ibrahim; Isikay, Ilkay; Soylemezoglu, Figen
    OBJECTIVE: To share our clinical experience of 25 years and identify prognostic factors for progression-free and overall survival in pediatric intracranial ependymomas. METHODS: In total, 61 children who were treated be-tween 1995 and 2020 in a single institution were included in the study. Medical records of the patients were retro-spectively reviewed to obtain and analyze the following data: patient age at first surgery, sex, presenting symptoms, hydrocephalus and any invasive treatment, anatomic site, extent of resection, pathologic grade, time to progression, and time to death. Progression-free and overall survival rates and affecting factors were analyzed by Kaplan-Meier method. RESULTS: Dysphagia, number of surgeries, and spinal seeding were associated with progression free and overall survival in univariate analysis. The extent of resection, World Health Organization grade, and visual problems were also associated with progression whereas sex was associated with overall survival. Cox regression identified the extent of resection and single surgery as an indepen-dent prognostic factor for progression-free survival. No independent factor was found for overall survival. CONCLUSIONS: This single center experience of 25 years confirms the beneficial effect of gross total resection on disease progression. Although spinal seeding seems to affect survival rates, greater number of cases are needed to reveal its full effect.
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    Early Decompressive Craniectomy in Acute Cerebral Infarctions
    (2023) Basar, Ibrahim; Akyol, Mehmet Edip; Kurt, Nurettin
    Objectives: Acute cerebral ischemic stroke resulting from occlusion of major arteries constitutes a significant cause of mortality and morbidity. Early decompressive craniectomy reduces mortality and enhances the proportion of patients achieving favorable functional outcomes. Methods: Data from patients who underwent decompressive surgery for acute cerebral ischemic stroke at our center between January 2018 and January 2023 were retrospectively analyzed. The demographic data, along with neuro- logical outcomes at 6 months, mortality, and morbidity rates, were analyzed of the patients to assess the role of early decompressive craniectomy in acute cerebral infarctions. Results: A total of 75 patients, 24 females and 51 males, who underwent decompressive surgery with a diagnosis of acute cerebral ischemia, were included in the study. Early surgery was defined as surgery performed within the first 72 hours of ischemia. It was observed that patients underwent early surgery had higher survival rates (p<0.036). Conclusion: Decompressive cranictomy is a significant treatment option for malignant stroke. The results of this study suggest that early decompressive surgery could be an effective treatment method in increasing the survival chances of patients with acute ischemic stroke.
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    The Effect of Hydrocephalus on the Optic Nerve in the Presence of Intracranial Mass
    (Elsevier Science Inc, 2024) Arpa, Abdurrahman; Yigit, Abdullah; Basar, Ibrahim; Yilmaz, Tevfik
    - OBJECTIVE: The measurement of optic nerve sheath diameter is a noninvasive, practical, and economical method used to identify increased intracranial pressure. The purpose of this study is to detect the preoperative and postoperative changes in optic nerve sheath diameter in patients with intracranial mass, to correlate these changes with optic nerve diameter variations, and to evaluate the impact of hydrocephalus on these alterations. - MATERIAL AND METHOD: This study was conducted with patients who presented to our clinic with complaints of intracranial mass, were decided for surgery, and underwent surgical procedures.- FINDINGS: The optic nerve and optic nerve sheath diameter measurement values were different preoperatively and postoperatively, with a significant decrease in the optic nerve sheath diameter in all groups in postoperative measurements, while the optic nerve diameter significantly increased. - CONCLUSIONS: Although there was no significant difference between the effects of hydrocephalus and intracranial mass-related increase in intracranial pressure on the optic nerve and optic nerve sheath, it was observed that hydrocephalus increased intracranial pressure when considering the Evans ratio. It has been determined that as ventricular dilatation increases, so does intracranial pressure, which leads to an increase in the diameter of the optic nerve sheath, resulting in papilledema and thinning of the optic nerve. These findings indicate the importance of early cerebrospinal fluid diversion and monitoring optic nerve sheath diameter in the management
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    Exogenous Amylase Reverses Cerebral Ischemia Induced by Selective Intraarterial Injection of Degradable Starch Microspheres: An Angiographic and Histological Study in a Novel in Vivo Animal Model
    (Turkish Neurosurgical Soc, 2022) Basar, Ibrahim; Hanalioglu, Sahin; Bahadir, Sinan; Isikay, Ilkay; Atilla, Pergin; Bilginer, Burcak; Arat, Anil
    AIM: To validate a new particulate embolization method using degradable starch microspheres (DSM) and intraarterial exogenous amylase administration, which allow for regulated temporary cerebral arterial embolization without compromising tissue perfusion. MATERIAL and METHODS: Twenty-four male New Zealand rabbits were randomly divided into three groups. All animals underwent routine angiography. The control group received no additional intervention. In the ischemia group, 0.2ml DSM was administered to the animals via the right carotid artery with pulsed, gentle injections to induce ischemia in the cerebral microcirculation. Animals in the reperfusion group received 0.05 ml of exogenous amylase along with DSM administration. Six hours after the procedure, the animals were sacrificed and histopathological analysis was performed. RESULTS: The ischemia group was the most adversely affected group by embolization, with the highest number of pyknotic neurons. The reperfusion group, which received exogenous amylase, had lower pyknotic neurons than the ischemia group. The pyknotic neuron count was similar in some regions between reperfusion and control groups. CONCLUSION: Exogenous amylase can rapidly attenuate cerebral ischemia caused by microembolization with DSM.
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    Neuroprotective effects of the combined treatment of resveratrol and urapidil in experimental cerebral ischemia-reperfusion injury in rats
    (Acta Cirurgica Brasileira, 2024) Cetin, Ridvan; Bahadir, Sinan; Basar, Ibrahim; Aslanoglu, Baris; Atlas, Burak; Kaya, Seval; Guzel, Baris Can
    Purpose: To evaluate the neuroprotective effect of resveratrol, urapidil, and a combined administration of these drugs against middle cerebral artery occlusion (MCAO) induced ischemia/reperfusion (IR) injury model in rats. Methods: Thirty-five rats were divided into five groups of seven animals each. Animals in IR, IR resveratrol (IRr), IR urapidil (IRu), and IR + combination of resveratrol and urapidil (IRc) were exposed to MCAO induced cerebral ischemia reperfusion injury model. Rats in IRr and IRu groups received 30-mg/kg resveratrol and 5-mg/kg urapidil respectively. Animals in IRc received a combined treatment of both drugs. At the end of the study, brain tissues were used for oxidative stress (malondialdehyde, glutathione, and superoxide dismutase), pro-apoptotic caspase-3, anti-apoptotic Bcl-2, and pro-inflammatory tumor necrosis factor-alpha cytokine level measurements. Results: The MCAO model successfully replicated IR injury with significant histopathological changes, elevated tissue oxidative stress, and upregulated apoptotic and inflammatory protein expression in IR group compared to control group (p < 0.001). All parameters were significantly alleviated in IRr group compared to IR group (all p < 0.05). In IRu group, all parameters except for caspase-3 and Bcl-2 were also significantly different than IR group (all p < 0.05). The IRc group showed the biggest difference compared to IR group in all parameters (all p < 0.001). The IRc had higher superoxide dismutase and Bcl-2 levels, and lower caspase-3 levels compared to both IRr and IRu groups (all p < 0.05). Also, the IRc group had lower MDA and TNF-alpha levels compared to IRu group (all p < 0.05). Conclusion: The results indicate that combined treatment of resveratrol and urapidil may be a novel strategy to downregulate neurodegeneration in cerebral IR injury.
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    Surgical management of sporadic hemangioblastomas located in the posterior fossa of brain
    (Pisa Univ Press, 2021) Basar, Ibrahim; Ozturk, Pinar Aydin; Tuncer, Mehmet Cudi; Turan, Yahya; Yilmaz, Tevfik
    Purpose: Hemangioblastomas (HBs) are highly vascular tumors, constituting 2%-3% of central nervous system (CNS) tumors. Surgery is a treatment option for HBs. The purpose of this study was to evaluate the demographic, clinical, and radiological findings of patients with HBs who were operated on via microsurgical technique at our clinic and to determine the findings specific to HBs and evaluate their pathological findings and confirmation. Methods: We evaluated age, gender, initial complaints and duration of 100 patients (50 female and 50 male patients), presence of cranial nerve deficits, magnetic resonance imaging, data (localization, presence of hydrocephalus, tumor size, enhancement pattern, and cystic and solid component features), resection rates, pathological findings (grade, Ki-67 ratio, and staining results), recurrence, special conditions of patients, and the final status of patients in this study. Results: Mean age was 39.08 +/- 14.77 years and 66.7% of the patients presented with cerebellar findings. Five of the cases were located in the brainstem, five were located in the cerebellopontine angle, and two were in the cerebellar cortex. In all patients, gross total resection was performed using arteriovenous malformation repair. Conclusions: Surgical intervention of small and cystic tumors can be performed safely with en bloc resection along with preoperative detailed imaging, improved microsurgical techniques, and an extensive understanding of anatomical and vascular structures. On the contrary, patients with a brainstem invasion and solid structure present surgical difficulties due to arteriovenous malformation-like vascularizations; therefore, gross total resection is the optimal treatment in HBs.