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    Evaluation of the skin flora after chlorhexidine and povidone-iodine preparation in neurosurgical practice
    (Elsevier Science Inc, 2009) Guzel, Aslan; Ozekinci, Tuncer; Ozkan, Umit; Celik, Yusuf; Ceviz, Adnan; Belen, Deniz
    Background: Currently, there are various antiseptics used for cleaning the skin before surgery, but there is no standard procedure in practice. Chlorhexidine and povidone-iodine are the most preferred compounds among antiseptics. Both are proved to be safe and effective for skin disinfection. In this study. our aim was to investigate the combined effects of chlorhexidine and povidone-iodine oil the skin's flora before neurosurgical intervention, consecutively. Methods: Randomly, 50 cranial and 50 spine neurosurgery cases were assigned to the Study. The first culture was obtained after hair removal and before cleaning the skin with any antiseptic. The second culture was obtained after the skin had been cleaned with chlorhexidine for 3 minutes. Then, the skin was cleaned twice with povidone-iodine for 30 seconds, and the third and fourth cultures were taken from the skin incision area. Bacteria were identified by means of standard laboratory identification methods. Positive culture results were compared statistically among order Of Cultures obtained. Results: In the first culture evaluation, 39 (33 cnS, 6 Staphylococcus aureus) of 50 cranial samples and 37 (33 cnS, 4 S aureus) of 50 spine samples showed reproduction. In the second culture, 9 cranial and 5 spine samples showed reproduction of cnS. In the third and fourth Cultures, no growth was observed (P < .001). Conclusion: Three minutes' cleaning of the incision area with chlorhexidine, followed by 30-second cleaning with povidone-iodine, could be a sufficient disinfection procedure for preoperative preparation of the skin in patients undergoing a neurosurgical procedure. (C) 2009 Elsevier Inc. All rights reserved.
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    Pituitary adenoma coexisting with a suprasellar arachnoid cyst
    (Turkish Neurosurgical Soc, 2007) Guzel, Asian; Er, Uygur; Tatli, Mehmet; Uzunlar, Ali Kemal; Belen, Deniz; Bavbek, Murat
    OBJECTIVE: Biochemical and radiological properties of sellar and parasellar lesions are quite similar in some instances. This leads to a difficulty in preoperative diagnosis. Here, a pituitary adenoma and a suprasellar arachnoid cyst in the same patient is presented, and possible etiopathogenetic mechanisms and surgical treatment are discussed. CASE: A 56-year-old male patient was admitted to the hospital with a history of seizures, urinary incontinence and visual disturbances. Preoperative MRI revealed a mass lesion in the sella turcica with suprasellar extension and a coexisting large supra- and parasellar cyst. DISCUSSION and CONCLUSION: A slow-growing mass lesion beneath the defective mesencephalic leaf of the Liliequist membrane may lead to a one-way valve system on its surface. It might be speculated that CSF will become trapped in the cyst during tumor growth. The other possible mechanism to explain the coexistence is discussed. In light of these comments and intraoperative observations, we suggest a third type of suprasellar arachnoid cyst. a semi-communicative type.
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    Surgical treatment of chronic subdural haematoma under monitored anaesthesia care
    (E M H Swiss Medical Publishers Ltd, 2008) Guzel, Aslan; Kaya, Sedat; Ozkan, Umit; Aluclu, M. Ufuk; Ceviz, Adnan; Belen, Deniz
    Questions under study: General and local uses of anaesthesia are the preferred common methods in the surgical treatment of chronic subdural haematoma (CSDH). The literature provides no information regarding monitored anaesthesia care during surgery of CSDH. In this report we evaluate the clinical results of surgical treatment for CSDH under monitored anaesthesia care. Method: Between 2001 and 2006 twenty consecutive patients with 24 CSDHs were surgically treated under monitored anaesthesia care at one institution. The clinical success of the procedure under monitored anaesthesia care, patient satisfaction, length of hospitalisation, anaesthesia-related complications and neurological outcome were analysed. Results: Mean age was 60.9 years, with 15 patients aged over 60. ASA physical condition score was IV in 11 patients, III in 1, II in 4 and I in 4. In all patients CSDH was successfully drained by burr hole craniotomy under monitored anaesthesia care. There was no anaesthesia-related morbidity or mortality. Mean hospital stay was 4.5 days. Conclusion: Preliminary results indicate that surgery for CSDH under monitored anaesthesia care is safe and effective. Conscious sedation using monitored anaesthesia care, that is a middle ground between general anaesthesia and local anaesthesia, may facilitate patient comfort and surgical competence during surgery for CSDH.