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Öğe Complete L1-L2 lateral dislocation without fracture and neurologic deficit in a child(Karger, 2006) Guzel, A.; Belen, D.; Tatli, M.; Simsek, S.; Guzel, E.Spinal injuries in the infantile age group are relatively rare, mainly due to anatomical and biomechanical features of the pediatric spine. With its hypermobile character, pediatric spine can withstand trauma without fracture, and the elastic nature of the young spine allows easy slippage between segments, especially under the age of 8. Clinically, a few of the cases present with subluxation only, which seldom involve the lumbar level. We report an extremely rare case of traumatic complete upper lumbar lateral lystesis in a 3-year-old boy. The patient was treated conservatively and followed up for 2 years with some degree of correction. Copyright (c) 2006 S. Karger AG, Basel.Öğe The effects of nimopidine on platelet aggregation in severe head injury(Springer-Verlag Wien, 2008) Tatli, M.; Guzel, A.; Kilincer, C.; Batun, S.Background. Severe head injury (SHI) is often associated with traumatic subarachnoid haemorrhage (tSAH), vasospasm, and results in an unfavorable outcome. The aim of this study was to evaluate the effect of nimodipine on platelet aggregation in SHI. Method. This prospective study consisted of 80 patients (53 male, 27 female; ages ranging from 17 years to 65 years, mean: 36.2 years) with severe head injury (Glasgow Coma Score, GCS < 8). All patients received antioedema therapy and prophylactic anticonvulsant. The patients were randomly assigned to either the nimodipine group (2 mg/h continuous infusion for one week) (n = 45) or the control group (n = 35). There were 13 patients with tSAH in the nimodipine group and 10 patients with tSAH in the control group. The platelet aggregation ratio (PAR) was measured on the initial day and the 7(th) day. Higher PAR indicates lower circulating platelet aggregates. Findings. The two groups were well matched for age, sex, mode of injury, neurological status and CT scan findings. In fact, comparison of PAR and GCS in the two treatment groups revealed no difference on the first day. Compared to initial values, the nimodipine group showed a significantly higher PAR value (0.6 +/- 0.1 vs. 0.9 +/- 0.2, p < 0.001) and mean GCS value (7.4 +/- 0.7 vs. 13.7 +/- 1.0, p < 0.001) on the 7(th) day. As a result, on the 7(th) day, the nimodipine group had a significantly higher PAR values (0.7 +/- 0.1 vs. 0.9 +/- 0.2, p < 0.001) and mean GCS (12.3 +/- 1.3 vs. 13.7 +/- 1.0, p < 0.001) as compared to the control group. When the analyses were repeated for the subgroups (the patients with tSAH or contusion) nimodipine showed the same effectiveness. Conclusions. Nimodipine effectively inhibits platelet hyperaggregability in severe head injury patients with or without traumatic subarachnoid haemorrhage. Thus, it may have a potential for use in these patients. However, its effect on long-term outcomes such as death and disability rates and quality of life is still to be determined.Öğe Malignant myoepithelioma of the external auditory canal: a case report(Wiley-Blackwell, 2009) Dirier, A.; Guzel, A.; Karadayi, B.; Ozekinci, S. O.; Tatli, M.[Abstract Not Available]Öğe Pediatric cerebral aneurysms: a report of 9 cases(Springer-Verlag Wien, 2008) Tatli, M.; Guzel, A.; Kilincer, C.; Goksel, H. M.Background. Intracranial aneurysms are rare in children, constituting less than 2% of all cerebral aneurysms. Relative to their adult Counterparts, published series are few and case numbers are small. Method. Nine children (5 males and 4 females, ages 13-18 years old) are reported. These patients constituted 6% of a total of 150 cerebral aneurysm cases treated at our institution over a 12-year period. Findings. Eight patients presented with subarachnoid haemorrhage; one patient's aneurysm was identified incidentally after head trauma. All but one of the patients were in good clinical grade (Hunt and Hess grades I to III). Aneurysm locations were: internal carotid artery (ICA) (5 cases), anterior communicating artery (2 cases), anterior cerebral artery (1 case) and vertebrobasilar junction (1 case). A giant (ICA bifurcation) aneurysm and bilateral ICA bifurcation aneurysms were each observed in one patient. Angiographic vasospasm was detected in three patients. Clinical deterioration attributable to vasospasm was observed in one of them. Seven patients underwent craniotomy, and aneurysms were clipped succesfully. One patient underwent endovascular coiling for a vertebrobasilar junction aneurysm. One patient died due to rebleeding before surgery on the second day of her initial haemorrhage. The 6-month Glasgow Outcome Score was 5 in seven patients and 4 in one patient. Conclusions. Our treatment regimen for pediatric aneurysms is similar to that used in adults, and consists of surgical clipping as the mainstay of treatment, with endovascular techniques reserved for selected cases. With the exception of one patient who died due to early rebleeding, this regimen resulted in good clinical outcomes.Öğe Spinal cord compression of primary extragonadal giant yolk sac tumor(Nature Publishing Group, 2007) Guzel, A.; Tatli, M.; Belen, D.; Seckin, H.Study design: Case report. Objective: To report an adult male patient witha primary extragonadal giant yolk sac tumor presenting with acute spinal cord compression. Setting: Faculty of Medicine, University of Dicle, Diyarbakir, Turkey. Method: A 31-year-old man was referred to our department witha diagnosis of Pott's disease, a complaint of back pain and gait difficulty for 2 weeks. Neurological examination showed spastic paraparesis and hypoesthesia below the L2 dermatome level. He also had urinary incontinence. Abdominal computed tomography and lumbar magnetic resonance imaging study revealed a giant cystic mass lesion located in the psoas muscle. Posteriorly, the third lumbar vertebral body was destructed and the tumor was compressing the dural sac. A combined anterior and posterior approach was performed. Pathological diagnosis was a yolk sac tumor. Result: His neurological status improved during the postoperative course. A chemotherapy protocol was given including bleomycin, etoposide and cisplatin. Five months after the last chemotherapy, he was brought to the emergency unit in sepsis and died despite antibiotherapy. Conclusion: Yolk sac tumor should be considered in young adult male patients presenting with acute paraparesis even without any signs or medical history of a testis tumor. These tumors may be unresectable; however, decompression of neural structures and stabilization of the spine with instrumentation may cause substantial improvement in neurological deficit and pain relief.Öğe Surgical Treatment of Cervical Arteriovenous Fistula in a Patient with Neurofibromatosis Type 1. A Case Report(Sage Publications Inc, 2007) Guzel, A.; Tatli, M.; Er, U.; Kazanci, A.; Ozturk, H. M.; Belen, D.Vasculopathies are frequently associated with neurofibromatosis type-1, and they are generally occlusive or stenotic type lesions. Vertebral arteriovenous fistula (AVF) is quite rare in neurofibromatosis type 1 patients. They can be treated with surgical excision or endovascular occlusion. We describe a surgically treated cervical AVF in a neurofibromatosis type 1 (NF-1) patient and discuss the selection of the patient for the surgery. Although endovascular occlusion is the first line treatment option for cervical AVFs, some selected cases can be successfully treated by surgery. Surgery should be considered as a treatment option in spite of its risks, especially for cervical AVF which is associated with fibromuscular system diseases like NF-1.Öğe Treatment of trigeminal neuralgia with glycerol injection at the gasserian ganglion(Masson Editeur, 2009) Sindou, M.; Tatli, M.Gasserian ganglion neurolysis with glycerol injected percutaneously through the foramen ovale continues to be widely used. Its long-term efficacy on pain is proportional to the degree of postoperative hypoesthesia. The advantage is low cost. The disadvantage is essentially the difficulty in controlling diffusion outside the Meckel cavity. Subsequently its effects are somewhat random and potential complications are difficult to prevent reliably. (C) 2009 Elsevier Masson SAS. All rights reserved.Öğe Treatment of trigeminal neuralgia with thermorhizotomy(Masson Editeur, 2009) Sindou, M.; Tatli, M.Percutaneous radiofrequency (RF) thermorhizotomy of the trigeminal nerve is an effective treatment for trigeminal neuralgia. Long-term efficacy is proportional to the degree of postoperative hypoesthesia. The advantage is the topographic selectivity of the thermolesion, provided the electrode tip is placed accurately. This requires precise x-ray guidance and neurophysiological testing. In addition to the indication in idiopathic trigeminal neuralgia. especially for elderly patients with precarious conditions. thermorhizotomy is particularly useful for treating patients with trigeminal neuralgia due to multiple sclerosis. It can also be applied to symptomatic neuralgias. but only when the main components are of the paroxysmal and/or the allodynic types: the thermorhizotomy method could aggravate permanent components. especially when burning pain predominates it could also increase preexisting trophic disturbances. particularly keratitis. (C) 2009 Elsevier Masson SAS. All rights reserved.Öğe Various surgical modalities for trigeminal neuralgia: literature study of respective long-term outcomes(Springer Wien, 2008) Tatli, M.; Satici, O.; Kanpolat, Y.; Sindou, M.Background. The literature contains many varying, often conflicting surgical results. However, there is no study comparing long-term effectiveness of all surgical procedures for trigeminal neuralgia (TN). The aim of the present analysis is to report the long-term outcomes of surgical options of TN since the development of electronic databases, to evaluate them with the same clinical and statistical criteria and determine the most appropriate treatment. Method. All studies that had a minimum 5 years or more (>= 5 years) mean duration of follow-up were included in the review. The identified studies were evaluated independently by two authors for quality using a modified inclusion criteria. The evaluated outcome measures of this study were, the initial acute pain relief (APR), follow-up pain free period and recurrence rates as well as complications. In comparisons of the data, the Student's t-test, Chi-square followed by Pearson's risk analysis tests were used. Kaplan-Meier actuarial analysis of pain free-survival curves were constructed for each surgical option that had enough data. Findings. Twenty-eight studies, mostly including microvascular decompression (MVD) and radiofrequency thermorhizotomy (RF-TR), that met the inclusion criteria were included in the review. The efficacy of MVD and percutaneous balloon microcompression (PBC) were similar (Odds ratio = 0.15, P > 0.05), and their effects were superior to those of the other modalities (P < 0.001). Although RF-TR provided a high initial pain relief, its average pain free rate was 50.4% for a mean follow-up of 5 years. The recurrence rate was high after RF-TR (46%), while the lowest recurrence rate (18.3%) was after MVD (P < 0.001). Within the long-term follow-up period recurrence of pain affects at least 19% of patients who undergo any surgical treatment for TN. Conclusions. The study suggests that each surgical technique for treatment of trigeminal neuralgia has merits and limitations. However, MVD provides the highest rate of long-term patient' satisfaction with the lowest rate of pain recurrence.
