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Öğe Assessment of cases with intracranial hydatid cyst: A 23-year experience(Ege Nöroloji Derneği, 2014) Turan, Yahya; Yılmaz, Tevfik; Göçmez, Cüneyt; Kamaşak, Kağan; Kemaloğlu, Serdar; Tekin, Recep; Hattapoğlu, Salih; Bozkaya, Halil; Çalışkan, Alper; Ceviz, AdnanObjective: Brain is involved in 1-2% of hydatid cyst infections. A cranial location is rare. In this study, we aimed to assess clinical findings, radiological investigations, and treatment modalities of cases with intracranial hydatid cyst. Materials and Method: The present study included 26 patients operated for cerebral hydatid cyst disease between January 1990 and October 2012. Results: Seventeen patients were male and 9 were female. The mean age of the study population was 20.3 years (range 7-50 years). Headache and nausea were the most common clinical symptoms. The lesions were demonstrated by computed tomography (CT) and magnetic resonance imaging (MRI) as large, smooth, thin walled, spherical-shaped, cystic homogenous lesions with the same density as cerebro spinal fluid, which showed no edema or contrast uptake. Two patients were complicated or infected cysts with perifocal edema and contrast uptake. In 20 patients, the cysts were removed completely with Dowlings technique, by rectifying cysts without rupturing. Eleven patients with ruptured cysts during operation, recurrent or systemic hydatid cyst were treated medically. Conclusion: Medical therapy appears effective in hydatid cyst disease. Cerebral hydatid cysts should be excised totally without rupturing them. Preoperative imaging techniques are central to surgical planning. Intracranial hydatid cyst should be remembered when CT or MRI shows a cystic lesion, especially in countries where hydatid cyst is endemic.Öğe Brain abcesses: Clinical analysis of twenty-five cases(Ege Üniversitesi, 2014) Yılmaz, Tevfik; Gül, Aylin; Turan, Yahya; Aydın, Pınar; Göçmez, Cüneyt; Kamaşak, Kağan; Hattapoğlu, Salih; Ceviz, AdnanObjective: The aim of this study is to determine the clinical, radiological, and surgical characteristics of brain abscesses and to share our experience in their management. Method: Medical records of 25 patients with brain abscess were retrospectively reviewed. The clinical picture, radiological examinations, treatment methods, and patient outcomes were analysed. Results: Of 25 patients included in our study, 16 (64%) were male and 9 (36%) were female. The age range was 2 months to 60 years, with a mean age of 12 years. Fifteen patients had a predisposing condition. The main source of the abscess was extension of an ear or nose infection to brain (n=9; 36%). In 10 (40%) patients the source could not be shown. Eighteen (72%) patients had a solitary abscess while 7 (28%) had multiple abscesses. No proliferation was observed in bacteriological cultures in 13 (52%) patients. No recurrences were seen in patients undergoing abscess excision with craniotomy. Conclusion: A brain abscess is a surgical emergency. Abcess excision with cranitomy is an effective treatment method in brain abcess cases. The most important sources of brain abcess were neigboring ear and nose infections. Diagnosis and treatment of these infections can prevent formation of brain abcess.Early diagnosis and treatment of cases with brain abscess can save patients from life-threatening complications of this disease.Öğe Evaluation of the surgical anatomy of sphenoid ostium with 3D computed tomography(Springer Verlag, 2014) Göçmez, Cüneyt; Goya, Cemil; Hamidi, Cihad; Teke, Memik; Hattapoğlu, Salih; Kamasak, KağanTo evaluate the anatomy of the sphenoid ostium (SO), which has so far only been investigated with the aid of two-dimensional computed tomography (CT) or using a cadaver, from a new point of view through the use of 3D CT for the first time. We have evaluated 50 patients who had CT angiography done for different reasons. The sphenoid sinus types and the SO were evaluated three dimensionally. The average diameters of the sphenoid ostia, and their distances to the midline, as well as to each other and the choana have been measured. In addition, the SO were categorized according to their shapes. The average age of the patients was 48.5. No SO was found in seven cases (14 %). The average distance of the SO to the midline was 2.78 mm on the right side and 2.77 on the left. Four different shapes of SO were determined; round, oval, irregular and linear. The average distance of the right and left SO to the choana was 15.22 +/- A 0.95 and 14.87 +/- A 1.11 mm, respectively. No statistically significant difference was found between the male and female sexes with regard to the calculated diameters and shapes of the SO (p > 0.05). The anatomy of the sphenoid sinus and the SO varies widely from individual to individual. We have demonstrated in our study that these anatomic variations could be evaluated pre-operatively. Using this imaging technique, surgeons can make a pre-operative 3D evaluation of the sphenoid ostium, encountered in the surgery and thus achieve better orientationÖğe Kaza ile üzerine cisim düşmesine bağlı hastaneye başvuran hastaların değerlendirilmesi(Dicle Üniversitesi, 2015) Turan, Yahya; Uysal, Cem; Korkmaz, Mustafa; Yılmaz, Tevfik; Göçmez, Cüneyt; Özevren, Hüseyin; Gören, Süleyman; Ceviz, AdnanAmaç: Özellikle çocuklarda olmak üzere ev, iş ve dış ortamlarda meydana gelen kazalar, yaralanma ve ölüm nedenlerinin başında gelmektedir. Bu çalışmada amaç, kaza ile üzerine cisim düşmesine bağlı hastanemize baş- vuran hastaların değerlendirilmesidir. Yöntemler: Bu çalışmamızda kaza ile üzerine cisim düş- mesine bağlı 2012-2014 yılları arasında hastanemize başvuran 135 hastanın dosyaları retrospektif olarak incelendi. Bu hastaların yaş, cinsiyet, olayın nedeni olarak üzerine düşen cismin türü, yeri, zamanı ve ölüm nedenleri analiz edildi. Bulgular: Hastaların 82 ( %60,7)’i erkek, 53 (%39,3)’ü kadın ve yaş ortalaması 18,8 (0-79 yıl) olarak bulundu. En fazla hasta %57,8 (78 hasta) ile çocuk yaş grubunda ( 0-18 yaş) bulunmaktadır. Düşen cismin türü bakımından değerlendirildiğinde sırasıyla %18,5 (25 hasta) ile televizyon, %15,6 (21 hasta) ile taş ve %11,1 (15 hasta) ile demirden yapılmış cisimler ilk üç sırayı paylaşmaktadır. Kazanın meydana geldiği yer olarak ele alındığında en fazla kazanın 85 vaka (%62,9) ile evde olduğu görülmektedir. Kazanın meydana gelme zamanına bakıldığında en fazla 93 vaka (%68,9) ile yaz mevsiminde meydana geldiği görülmektedir. Sonuç: Bu çalışmada elde edilen veriler, özellikle çocukların maruz kaldığı bu tür kazaları önleme programlarına katkı sağlamaktadır.Öğe Myelodisplazik hastalarda nöroürolojik komplikasyonlar(Dicle Üniversitesi Tıp Fakültesi, 2014) Kaplan, Sümeyye Çoruh; Göçmez, Cüneyt; Dağgülli, MansurSpina bifida yaşamla bağdaşan konjenital anomaliler arasında sık rastlanılan patolojilerdendir. Embriyolojik dönemde nöral tüpün kapanma defektleri açık ya da kapalı spinal disrafizmle sonuçlanır. Günümüzde nöroşirurjikal tekniklerin ilerlemesiyle hastaların multidisipliner takibi, yaşam kaliteleri açısından önem kazanmıştır. Ürolojik komplikasyonların önlenmesi ve tespit edilmesi bakımından da bazı yaklaşımlar standardize edilmiştir. Olguların uzun dönem takibinde nöroşirurjikal açıdan prognozun yanı sıra eşlik edebilen tüm patolojilerin akılda tutulması ve bu amaçla hastaya yön gösterilmesi önemlidir. Bu yazıdaki amaç Spina bifida hastalarında mevcut olabilecek ürolojik problemleri ve bunlarla ilgili son çalışmaları gözden geçirmektir.Öğe Önemli bir tetraparezi nedeni: Servikal spondilotik miyelopati(Dicle Üniversitesi Tıp Fakültesi, 2013) Göçmez, Cüneyt; Kamaşak, KağanServikal spondilotik miyelopati (SSM) servikal omurlarda dejeneratif değişiklikler sonucunda gelişen spinal kanalda daralmaya bağlı nörolojik bir bozukluktur. Spondiloz, omurilik ve sinir köklerini, bir veya birden fazla segmentte etkileyerek miyelopati oluşturabilmektedir. Gelişmiş ülkelerde 55 yaş üzerindeki olgularda en sık rastlanan miyelopati nedenidir. Ayrıca hayatın orta ve ileri dönemlerinde en sık karşılaşılan kazanılmış spastik paraparezi nedenidir. Bu yazıda SSM’nin tanı ve alternatif tedavi yöntemleri tartışıldı.Öğe Paraplegia due to missed thoracic meningioma after lumbar spinal decompression surgery: A case report and review of the literature(Dicle Üniversitesi Tıp Fakültesi, 2014) Bozkurt, Mehtap; Göçmez, Cüneyt; Okçu, Mehmet; Türkcü, Gül; Em, Serda; Oktayoğlu, Pelin; Uçar, Demet; Nas, KemalSpinal meningiomas are often localized to the thoracic level and symptoms from a spinal meningioma are determined by the location of the mass. We present a case of thoracic paraplegia due to a thoracic spinal cord tumor (meningioma) that was not detected during lumbar spinal decompressive surgery. Thoracic mass was detected in level of T2-3 on magnetic resonance imaging (MRI). The patient was re-operated and the patient’s neurologic symptoms were partially relieved. Surgeons should know that a thoracic silent meningioma can aggrevate neurological symptoms after lumbar spinal decompression surgery and should inform their patient before surgery.Öğe Penetrating cervical spinal cord injury: CT and MRI findings(2011) Gümüş, Hatice; Tekbaş, Güven; Önder, Hakan; Ekici, Faysal; Göçmez, CüneytBackground: Stab wounds resulting spinal cord injury (SCI) are relatively rare and typically associated with immediate neurological damage. Objectives: We report MDCT and MRI findings of spinal injury findings following an unusual penetrating stab wound of the neck. Case report: A 31-year-old man had a stab wound in the cervical region. CT showed linear fracture in the corpus and left lamina of fourth cervical vertebra. MRI revealed left side oriented posteroanterior penetrating linear spinal cord lesion and broad T2W hyperintensity changes representing spinal cord contusion. Conclusion: CT and MRI allow bony injuries, foreign bodies, spinal instability and the classification of different types of lesions, ranging from spinal cord edema to complete spinal cord transection. MR imaging should be performed after acquiring negative CT imaging findings in the case of high suspicion of spinal cord trauma as seen in our present case.Öğe Posterior epidural migration of a sequestered lumbar intervertebral disc fragment(Turkish Neurosurgical Society, 2017) Turan, Yahya; Yılmaz, Tevfik; Göçmez, Cüneyt; Özevren, Hüseyin; Kemaloğlu, Serdar; Teke, Memik; Sarıyıldız, Mustafa Akif; Ceviz, Adnan; Temiz, CüneytAIm: Posterior epidural migration of a sequestered lumbar intervertebral disc fragment (PEMSLIDF) is an extremely rare condition published so far only as case reports or small case series (ranging between 2 to 8 cases). Diagnosing this condition is often challenging and the diagnosis is usually made intraoperatively. The affected patients usually suffer cauda equina syndrome (CES). In the present study, we aimed to discuss the clinical and radiological findings, types and features of surgical therapies, and outcomes of 9 patients with PEMSLIDF. MaterIal and Methods: This study included 9 (0.36%) patients with PEMSLIDF among 2470 patients who underwent lumbar disc hernia surgery between August 2002 and September 2012. The preoperative clinical and radiological properties of the patients were evaluated. The postoperative outcomes were assessed using neurological examination, radiological imaging, visual analog scale (VAS) and modified Odom criteria. Results: RESULTS: As far as we know, this study is the largest case series examining the characteristics of PEMSLIDF. Seven (77.8%) of our patients were male and 2 (22.2%) were female and they had a mean age of 49.5 years (range 28-70 years). The mean duration from symptom onset to hospital admission was 7.4 days. Seven patients had CES. All patients underwent sequestrectomy and discectomy via posterior microsurgery. The patient outcomes were evaluated by the Modified Odom criteria and the outcome was excellent in two (22.2%) patients, good in 4 (44.5%), fair in 2 (22.2%), and poor in 1 (11.1%). ConclusIon: The entire free fragment can usually be excised via the posterior microsurgery technique. Early surgical treatment is of great importance to prevent more serious neurological deficits.Öğe Prognostic factors in cervical spondylotic myelopathy: A clinical prospective study(Lippincott Williams and Wilkins, 2015) Göçmez, Cüneyt; Koç, Rahmi Kemal; Tücer, Bülent; Menkü, Ahmet; Kurtsoy, AliObjective: Various factors may affect the surgical outcome in patients with cervical spondylotic myelopathy (CSM). The purpose of the present study was to determine these factors based on preoperative radiologic and clinical data. Methods: A total of 50 patients who underwent surgery for CSM and were followed up for at least 12 months postoperatively were enrolled in the study. The patients' preoperative and final neurologic status was assessed using the Japan Orthopedic Association (JOA) scoring system. JOA scores and prognostic factors such as sex, age, duration of symptoms, sagittal alignment, number of disks compressed, signal intensity on T1-weighted and T2-weighted magnetic resonance (MR) images, and the diameter of the spinal channel were evaluated. Results: The average preoperative and postoperative JOA scores were 10.9±3.4 and 15.0±2.4, respectively. The mean percentage of improvement for patients with CSM was 62.6±25.0% (P<0.05). The effects of sex difference, number of disks involved, and sagittal alignment on prognosis were not statistically significant (P>0.05). However, patients younger than 50 years, with duration of symptoms <1 year and no signal increase on T2-weighted MR images were predicted to have more neurologic improvement (P<0.05). Conclusions: We found that sex, number of degenerated disks, and sagittal alignment had no effect on prognosis. Notably, age below 50 years, duration of symptoms <1 year, and no signal increase on T2-weighted MR images affected surgical outcomes positively.Öğe Sleep disturbance in lumbar spinal stenosis(Journal Of Musculoskeletal Pain, 2014) Batmaz, İbrahim; Sarıyıldız, Mustafa Akif; Göçmez, Cüneyt; Bozkurt, Mehtap; Yıldız, Mehmet; Çevik, RemziObjectives: To determine the frequency of sleep disturbance in patients with lumbar spinal stenosis [LSS] and to reveal the relationship between the specific components of sleep disturbance and low back pain, physical disability, and psychological status in LSS. Methods: Thirty-six LSS patients [14 males and 22 females] and 30 age-and gender-matched healthy normal controls [13 males and 17 females] were enrolled in the study. Sleep disturbance was assessed using the Pittsburgh Sleep Quality Index [PSQI]. Pain was measured using a visual analog scale [VAS, 0-100 mm]. Psychological status and physical disability were assessed using the Hospital Anxiety and Depression Scale [HADS] and the Oswestry Disability Index [ODI]. Results: There were no significant differences between the LSS patients and the controls in terms of age or sex. The LSS patients had higher PSQI, HADS scores compared to the controls [p < 0.05]. Sleep disturbance [PSQI total score greater than 5] was positively correlated with VAS, HADS, and ODI [p < 0.05]. Conclusions: Sleep disturbance was associated with higher levels of pain, disability, depression, and anxiety. Sleep disturbance should be assessed when treating patients with LSS.Öğe Spinal tümörü taklit eden servikal intradural intramedüller apse: Nadir bir olgu(Dicle Üniversitesi Tıp Fakültesi, 2014) Yılmaz, Tevfik; Göçmez, Cüneyt; Turan, Yahya; Tekin, Recep; Yünce, Muharremİntramedüller spinal kord apseleri, oldukça nadir görülen, spinal kord tümörünü taklit edebilen, morbitide ve mortalitesi yüksek bir infeksiyondur. Bu hastalarda tanı koymak oldukça zordur. Üç yaşındaki erkek hasta huzursuzluk, boyun hareketlerinde kısıtlılık, kol ve bacaklarda ilerleyici güçsüzlük, idrar ve gaita retansiyonu şikayeti ile kliniğe yatırıldı. Hastanın çekilen kontraslı Servikal MRG’sinde spinal kord içerisinde C3-C7 vertebra düzeyinde kordda ekspansiyona neden olan kitle izlendi. Hastaya ampirik olarak Vankomisin 60 mg/kg/gün ve Seftriakson 100 mg/ kg/gün başlandı. Cerrahi girişim ile püy şeklindeki kistik materyal aspire edildi ve myelotomi ile belirgin bir kist duvarı olmadığı izlendi. Lezyondan alınan materyalden yapılan kültürde Metisilin duyarlı Stapylococcus aureus üredi. Postop dönemde motor ve sfinkter fonksiyonları düzelen hastanın parenteral tedavisi 21 güne tamamlanarak, oral antibiyotik ile taburcu edildi. Servikal intradural intramedüller apseler son derece nadir görülmektedir. Erken tanı ve tedavi ile kalıcı omurilik hasarlanmaları önlenebilmektedir. Spinal kitle ile başvuran hastalarda ayırıcı tanıda mutlaka intramedüller apse de akılda tutulmalıdır.Öğe Therapeutic effects of thymoquinone in a model of neuropathic pain(Excerpta Medica Inc., 2014) Çelik, Feyzi; Göçmez, Cüneyt; Karaman, Haktan; Kamaşak, Kağan; Kaplan, İbrahim; Akıl, Eşref; Tüfek, Adnan; Güzel, Abdülmenap; Uzar, ErtuğrulBackground: The goal of our study was to determine the therapeutic effects of thymoquinone in a dose-dependent manner in a model of neuropathic pain following an experimentally applied spinal cord injury (SCI). Methods: Fifty female adult Wistar albino rats weighing between 220 and 260 g were included in the study and were divided into 5 groups as follows: Group S (sham), Group C (control), Group T100 (100 mg/kg thymoquinone), Group T200 (200 mg/kg thymoquinone), and Group T400 (400 mg/kg thymoquinone). To begin the experiment, SCI was applied to all groups (with the exception of the sham group) following a mechanical and heat-cold test. Two weeks later, the mechanical and heat-cold tests were repeated, and a single normal saline dose was given to the sham and control groups, whereas 3 varying doses of thymoquinone were given to the other groups. The mechanical and heat-cold tests were repeated at 30, 60, 120, and 180 minutes after receiving thymoquinone. Finally, the animals were put to death via the removal of intracardiac blood. The levels of nitric oxide, total oxidant status, total antioxidant status, paraoxonase, malondialdehyde, tumor necrosis factor-?, and interleukin-1? were determined in all of the blood samples. Results: The withdrawal threshold and withdrawal latency values recorded from the mechanical and heat-cold allodynia measurements for all 3 thymoquinone groups were higher than that of the control group at all time points (ie, 30, 60, 120, and 180 minutes). There were no differences in these results between the 3 thymoquinone groups. The paraoxonase and total antioxidant status serum levels of all 3 thymoquinone groups were higher than those of the control group, whereas total oxidant status, nitric oxide, malondialdehyde, interleuken-1?, and tumor necrosis factor-? levels were lower in the 3 thymoquinone groups than in the control group. Conclusions: Thymoquinone is beneficial for decreasing experimental neuropathic pain following SCI. However, increasing the dose does not change the effect.
