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Öğe Anatomoradiological landmarks for accuracy of radiofrequency thermorhizotomy in the treatment of trigeminal neuralgia(Lippincott Williams & Wilkins, 2008) Tatli, Mehmet; Sindou, MarcOBJECTIVE: The correct positioning of the electrode is of prime importance for effectiveness and selectivity of percutaneous trigeminal radiofrequency thermorhizotomy (RF-TR) for the treatment of trigeminal neuralgia (TN). The aim Of Our study was to establish some anatomoradiological landmarks for the purpose of accurate placement of the electrode tip in RF-TR. METHODS: Of 1000 patients who underwent RF-TR, 100 were retrospective and randomly selected and divided into Study groups according to postoperative hypoesthesia in the trigeminal nerve divisions. The patients' petroclival angle, petroelectrodal angle, electrode tip, and the petroelectrodal angle/petroclival angle ratio were calculated on lateral cranial x-rays. These measurements were then correlated with the topography of hypoesthesia obtained by the RF-TR to define the anatomoradiological x-ray landmarks corresponding to the divisions of the trigeminal root. The postoperative hypoesthesia groups were correlated with their respective preoperative pain topography to check the accuracy of the thermolesion. in addition, the intraoperatively evoked paresthesia responses and the side effects were evaluated. The results were analyzed using a paired-samples Student's t test, the chi(2) test, and one-way analysis of variance, followed by Bonferroni and Tamhane post hoc tests. RESULTS: All study groups were comparable with respect to age, sex, side effects, electrode tip location, side of TN, and values of petroclival angle. The lowest values of petroelectrodal angle/orbitomeatal electrodal angle and petroelectrodal angle/ petroclival angle were detected in patients With V-3 TN, whereas the greatest values were in patients who had TN in all branches of the trigeminal nerve. The greatest height of the electrode was in patients who had TN in all branches, whereas the least height was in patients with V-3 TN. When the results were compared with each other, the mean differences were found to be statistically significant between V3 TN patients and the other groups with different P values. There was no statistical difference between the postoperative hypoesthesia data and the preoperative pain topography, which demonstrated evidence of the accuracy of the thermolesion in our series. CONCLUSION: Our data suggest that the determination of the presented landmarks allows customization to individual patient anatomy and may help the Surgeon achieve a more selective effect with a variety of percutaneous procedures for each branch of the trigeminal root.Öğe Anesthesia dolorosa caused by penetrating cranial injury(Karger, 2006) Tatli, Mehmet; Keklikci, Ugur; Aluclu, Ufuk; Akdeniz, SedatAnesthesia dolorosa (AD) is an uncommon complication of surgical treatments for trigeminal neuralgia. Its incidence is around 0.8%. To our best knowledge, AD caused by a penetrating cranial injury has not been reported previously. We report the case of a 31-year-old male patient with left-sided neuropathic keratitis and AD that began 18 years earlier, following a penetrating cranial injury with a knife to the left postauricular area. The patient was successfully treated by a carbamazepine and gabapentin combination. In conclusion, penetrating cranial injury is uncommon but may cause a serious neurologic disturbance. In the differential diagnosis of AD, a penetrating injury should be kept in mind. In these cases, treatments should be effective and immediate; otherwise, this may result in catastrophic consequences such as neurotrophic keratitis and blindness. Ophthalmologists should be aware of these potential problems. Copyright (c) 2006 S. Karger AG, Basel.Öğe Atretic parietal cephalocele(Karger, 2007) Guzel, Aslan; Tatli, Mehmet; Er, Uygur; Bavbek, Murad[Abstract Not Available]Öğe Bilateral temporal arachnoid cysts associated with tuberous sclerosis complex(Sage Publications Inc, 2007) Tatli, Mehmet; Guzel, AslanThe association between tuberous sclerosis complex and intracranial abnormalities such as hemimegalencephaly, schizencephaly, intracranial arterial aneurysms, and corpus callosum agenesis/dysplasia has been reported in the recent literature. However, the association between tuberous sclerosis complex and bilateral temporal arachnoid cysts has not been reported. A case of an 8-year-old boy with a mental impairment and epileptic seizures that began 5 years earlier is presented. The neuro-radiological findings are consistent with tuberous sclerosis complex associated with bitemporal arachnoid cysts. His epileptic seizures were treated with antiepileptic medications. To the authors' knowledge, this is the first reported case of tuberous sclerosis complex associated with bilateral arachnoid cysts of the temporal region. In such cases, arachnoid cysts may exacerbate the clinical picture.Öğe Comparison of the effects of maternal protein malnutrition and intrauterine growth restriction on redox state of central nervous system in offspring rats(Elsevier, 2007) Tatli, Mehmet; Guzel, Aslan; Kizil, Goksel; Kavak, Vatan; Yavuz, Murat; Kizil, MuratBoth maternal protein malnutrition and intrauterine growth restriction (IUGR) have deleterious effects on brain development, but a comparison of these effects has not been previously reported. The objectives of this study were to investigate and compare the effects of both factors on the oxidative status of the central nervous system (CNS), including the spinal cord, in offspring rats. We evaluated various parameters of oxidative status and antioxidant enzyme activities of superoxide dismutase and catalase (CAT) in different regions of the CNS from 60-day-old rats subjected to prenatal and postnatal protein restrictions [middle protein restriction 12%, severe protein restriction (SPR) 4%] or IUGR produced by uterine artery ligation. Furthermore, we compared these study groups to each other and to control rats fed an isocaloric 24% protein diet. Results were analyzed using one-way ANOVA followed by Tukey's post hoc test. Both protein restrictions and IUGR altered various parameters of oxidative status. In all evaluated structures, protein restrictions resulted in increases in thiobarbituric acid-reactive substances level and index of lipid peroxidation (P < 0.001), and in decreases in antioxidant enzyme activities (P < 0.005). IUGR also increased lipid peroxidation levels in the blood samples (P < 0.04) and protein oxidative damage in the cerebellum and cerebral cortex (P < 0.005); however, no effects were detected on the spinal cord. The greatest decrease in CAT activity was in the cerebellum of rats fed with SPR diet (P < 0.001). This study suggests that not only severe but also middle protein malnutrition have deleterious effects on CNS structures, including the spinal cord. Protein restriction has a greater effect on the redox state of the CNS than IUGR. (c) 2007 Elsevier B.V. All rights reserved.Öğe Could platelet aggregation ratio be an indicator for differential diagnosis of transient ischemic attack and cerebral ischemic stroke?(Karger, 2006) Tatli, Mehmet; Guzel, Aslan; Akyuz, Aytekin; Batun, SabriBackground: Platelet aggregation plays an important role in the pathogenesis of thromboembolic cerebrovascular disease. Platelet aggregation ratio (PAR) and its derivates have been used successfully to identify the effectiveness of antiplatelet agents and their optimum dosage in patients suffering from stroke. However, we failed to find any study using PAR as a predictive factor in differential diagnosis of ischemic cerebrovascular diseases. In this study, we aimed to investigate PAR in patients with acute ischemic stroke and transient ischemic attack (TIA), comparing their neuroradiological features, and whether PAR values could be an indicator for differential diagnosis of TIA and cerebral ischemic stroke. Methods: The study consisted of 75 adult patients who were admitted with suspected stroke and 25 control healthy individuals. All patients were diagnosed with acute ischemic stroke or TIA and the diagnoses were confirmed by clinical examination and computed tomography (CT). The stroke group consisted of 45, and the TIA group of 30 consecutive patients. The patients included in this study had noncardioembolic stroke. PAR values were measured on admission in all groups, according to the modified method of Wu and Hoak. The statistical significance of differences was evaluated using one-way ANOVA, the unpaired Student t test and the Bonferroni and Tamhane post hoc tests. Results: Differences in PARs between the control and TIA groups, control and stroke groups and stroke and TIA groups were significant (p < 0.001). Nevertheless, in each group, differences between genders were not statistically significant. Initial CT scan demonstrated early infarction sign in 26 stroke patients (57%); however, in 19 stroke patients, it was not detected. Differences in PARs between TIA and stroke patients, whose initial CT scan findings were negative, were found to be significant. However, differences in PARs between CT negative stroke patients and positive stroke patients were not significant. Conclusion: We believe that the use of PAR values in the assessment of acute ischemic stroke and TIA could open up a new perspective in the management of such patients. In differential diagnosis, PAR values have to combine with neurological examination and CT scan signs. The current test is not able to differentiate vascular occlusive diseases in other organs from vascular occlusive problems in the brain. Further study is needed to determine the sensitivity and specificity of this test in all patients and to confirm the prognostic value in stroke patients. Copyright (c) 2006 S. Karger AG, Basel.Öğe Effects of maternal protein malnutrition and intrauterine growth restriction on redox state of the central nervous system in offspring rats(Wiley-Liss, 2007) Tatli, Mehmet; Guzel, Aslan; Kizil, Goksel; Kavak, Vatan; Yavuz, Murat; Kizil, Murat[Abstract Not Available]Öğe Evaluation of platybasia in patients with idiopathic trigeminal neuralgia(Elsevier Science Inc, 2007) Kanpolat, Yucel; Tatli, Mehmet; Ugur, Hasan Caglar; Kahilogullari, GokmenBackground: Vascular compression of the trigeminal nerve is generally accepted as the primary source causing TN. To date, skull base bone deformity associated with ITN has been reported in only a number of case reports. The aim of the present study was to investigate one such skull base deformity, platybasia, in ITN patients in comparison with a randomized control population. Methods: Basal angle values reflecting the development of platybasia were measured in 25 patients with ITN and compared with the measurements in 25 control subjects. Results: Basal angle measured to investigate the existence of platybasia was found significantly wider in the ITN group (t = 3.90; P < .001), although platybasia was present in only 10 patients. Moreover, the average angle was also greater in the study group than in the control group, and the difference was statistically significant. Platybasia was found in 10 patients, whereas it was detected in only 2 control individuals; difference in platybasia incidence between the 2 groups was also statistically significant (chi(2) = 7.01; P < .01). Conclusion: Our data demonstrated that platybasia affecting the bony walls of the posterior fossa may play an important role in the pathogenesis of vascular abnormalities causing TN. (c) 2007 Elsevier Inc. All rights reserved.Öğe An experimental Staphylococcus aureus meningitis model for investigating induced leptomeningeal and subpial inflammation in rats(Maghira & Maas Publications, 2007) Guzel, Aslan; Er, Uygur; Tatli, Mehmet; Aluclu, Ufuk; Ozekinci, Tuncer; Nergiz, Yusuf; Ahishali, BulentOBJECTIVE: To evaluate leptomeningeal and subpial inflammatory responses of experimental Staphylococcus aureus bacteriemia following intraperitoneal and intravenous applications and to compare the inflammatory reactions in different regions of central nervous system. MATERIAL AND METHODS: Forty anesthetized rats were divided into four groups equal in number. The rats in group-I were given 1 ml suspension of Staphylococcus aureus intraperitoneally. Group-II was the control group of group I; it was administrated 1 ml 0.9% NaCl in water intraperitoneally. The rats in group-III were given the same amount of bacteria intravenously. Group IV was the control group of the group-III; it was administrated 1 ml 0.9% NaCl solution intravenously. The rats were sacrificed on the 21st day. Inflammatory changes of different regions of the central nervous system were examined under transmission electron microscopy. Statistical analysis was done by using variance analysis, Bonferroni, Tamhane post hoc, Student's t and univariate tests. RESULTS: Thoracic and occipital regions were the most vulnerable zones. Increasing of collagen tissue was the most detected inflammatory change. CONCLUSION: This experimental model can be used for inducing subpial and leptomeningeal inflammations and it maybe developed for investigations of pathogenesis of leptomeningitis during systemic infections.Öğe Falls from height in childhood in Diyarbakir province: a questionnaire study combined with clinical data(Turkish Assoc Trauma Emergency Surgery, 2009) Guzel, Aslan; Ceylan, Ali; Tatli, Mehmet; Basogul, Mehmet; Ozer, Nuri; Kahraman, Recep; Salcan, TarikBACKGROUND In Diyarbakir, the rate of falls from height increases during summer months since people sleep on the unprotected balconies and roofs of their houses. We aimed to determine the frequency of falls from height and the related risk factors. METHODS We used questionnaire method and clinical data in this study. The questionnaire was administered in 1445 residences. Clinical data were obtained from files of patients hospitalized due to trauma in the Neurosurgery Clinic of Dicle University over the last six years. RESULTS In this questionnaire study, it was determined that 246 people had fallen, their average age was 15.4 years, 98% of them had fallen accidentally (mostly from 3.6 m height in summer months), mortality was 6.9%, and the prevalence of falls from height over the previous six years was 472/100,000. Of 464 patients who were hospitalized during the last six years, 326 were cases of fall from height and 59% of these patients were falls from a roof. The average age of these patients was 8.9 years, and average height of the fall was 4.2 m. CONCLUSION Falls from height, particularly from roofs in Diyarbakir, remain a serious problem in terms of public health.Öğe Intradiploic Meningioma With Inward and Outward Extensions in a Rheumatoid Arthritis Patient(Journal Neurological Sciences, 2010) Er, Uygur; Guzel, Aslan; Tatli, Mehmet; Ceviz, Adnan; Sav, AydinBackground: Meningiomas usually arise from clusters of arachnoidal cap cells. Originating of a meningioma in an intraosseous region is rare condition. There are several theories about occurrence of these types of meningiomas. Here we report a case of an intradiploic meningioma in a rheumatoid arthritis patient and discuss the mechanism of developing intraosseous meningiomas, differential diagnosis of intraosseous lesions of calvarium, relations of rheumatoid arthritis and extensions of meningioma outside the diploe. Case description: A sixty three-year-old female patient who had been under the treatment for rheumatoid arthritis was admitted to the hospital with a swelling around her right eye. Bony window of preoperative CT showed an expansile right sphenoid bone lesion. The mass was excised with internal and external tables of the temporal bone by craniectomy. Conclusion: We advocate a wide resection, followed by cranioplasty with acrylic. If the subtotal resection is possible, residual lesion should be followed for adjuvant radiation therapy.Öğe Large primary cerebral hydatid cysts in children(Riyadh Armed Forces Hospital, 2006) Tatli, Mehmet; Guzel, Aslan; Altinors, NurHydatid cyst disease in childhood is still a serious health problem in the rural areas of Turkey and other places where the parasite is endemic. The brain involvement rate varies from 1-2% in hydatid disease. Especially in children, hydatid cysts can grow to enormous sizes, and the cases can remain neurologically intact. In this report, a 7-year-old boy, a 15-year-old girl, and a 10-year-old girl, in whom large primary brain hydatid cysts were diagnosed radiologically and treated surgically, are presented. Severe headache in childhood should be taken into consideration carefully in countries where hydatid disease is seen.Öğe Melkersson-Rosenthal syndrome with partial oculomotor nerve palsy(K Faisal Spec Hosp Res Centre, 2008) Aluclu, Mehmet Ufuk; Keklikci, Ugur; Guzel, Aslan; Unlu, Kaan; Tatli, Mehmet[Abstract Not Available]Öğe Multifocal Ewing's sarcoma of the brain, calvarium, leptomeninges, spine and other bones in a child(Elsevier Sci Ltd, 2008) Guezel, Aslan; Tatli, Mehmet; Er, Uygur; Yimaz, Fahri; Bavbek, MuradEwing's sarcoma (ES) is a malignant osseous neoplasm that mostly affects children and young male adults, and usually presents as a solitary bony lesion. Multifocal ES of the central nervous system is extremely rare, with an incidence ranging from 1.1% to 4.3%. Clinically, ES may mimic osteomyelitis. In this report, we describe the case of an 11-year-old boy who had multiple calvarial, leptomeningeal, spinal and various other bony lesions of ES, which were diagnosed radiologically and histopathologically. To the best of our knowledge, this is the first time that multiple brain, calvarial and spinal lesions of ES in a single patient have been reported in the English-language literature. We discuss possible mechanisms and differential diagnoses for this rare pathology. (C) 2007 Elsevier Ltd. All rights reserved.Öğe Pituitary adenoma coexisting with a suprasellar arachnoid cyst(Turkish Neurosurgical Soc, 2007) Guzel, Asian; Er, Uygur; Tatli, Mehmet; Uzunlar, Ali Kemal; Belen, Deniz; Bavbek, MuratOBJECTIVE: 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.Öğe Pituitary Carcinoma Presenting With Multiple Metastases: Case Report(Sage Publications Inc, 2008) Guzel, Aslan; Tatli, Mehmet; Senturk, Senem; Guzel, Ebru; Cayli, Suleyman Rustu; Sav, AydinPituitary carcinoma, an uncommon tumor in adults, generally presents with craniospinal and systemic metastases. We report a case of pituitary carcinoma with multiple craniospinal metastases in a child. A 9-year-old girl, who had had a ventriculoperitoneal shunt operation 3 years ago, presented with complaints of progressive visual disturbance, headache, speech difficulty, and gait disturbance for the past 2 months. Neurological examination revealed papilledema, visual loss, and dysarthria. Cranial magnetic resonance imaging revealed a large contrast-enhanced tumor in the left frontal region together with multiple lesions in the sellar-parasellar region and posterior fossa. Multiple intraspinal contrast-enhanced metastatic lesions were also seen. Histopathological and immunohistochemical examination of the excised left frontal mass revealed pituitary carcinoma. Treatment with cyclic temozolomide was started after the operation, but the patient died after 2 months Without response to medical therapy. This is the first pediatric case, to the authors' knowledge, Of a pituitary carcinoma with widespread intracranial and intraspinal metastases.Öğe Posttraumatic intraventricular arachnoid cyst accompanied by pseudomeningoencephalocele in a child(Churchill Livingstone, 2007) Guzel, Aslan; Tatli, Mehmet; Kilincer, Cumhur; Yilmaz, FahnBurkholderia pseudomallei infection of the central nervous system (CNS) is rare with less than 50 cases reported over the last 30 years. The retrospective melioidosis study at University Malaya Medical Centre has documented three cases of CNS melioidosis out of more than 160 cases of melioidosis since 1978. There were two patients with brain abscess and one with spinal epidural abscess. The predisposing factors were: one patient was an aboriginal farmer and the other two were diabetic. Their age ranged from 17 to 45 years. Prominent neurological features were limb weakness, cranial nerve palsy (6th and 7th) and visual disturbance. CT brain scan and MRI spine showed abscess formation, subdural collection, and spinal epidural collection, osteomyelitis of vertebra and occipital bone and also sagital sinus thrombosis. All these patients underwent surgical drainage leading to bacteriological diagnosis as well as appropriate long-term antibiotic therapy. All had good recovery at 6 months after completion of treatment. (c) 2006 Elsevier Ltd. All rights reserved.Öğe Primary cerebral intraventricular hydatid cyst: A case report and review of the literature(Sage Publications Inc, 2008) Guzel, Aslan; Tatli, Mehmet; Maciaczyk, Jaroslaw; Altinors, NurIntracranial hydatid cysts, which are common in certain areas worldwide, almost always develop at an intraparenchymal site. However, the literature on intraventricular hydatid cysts consists of only 6 independent case reports and about 30 cases that are described in large series. We report on a 10-year-old girl who was admitted with an intracranial cyst. She complained of headache of 10 months' duration that had intensified significantly over the 3 weeks immediately before her admission. The results of a neurologic examination showed bilateral papilledema and slight left hemiparesis. Magnetic resonance imaging revealed a right temporo-parieto-occipital cystic lesion that was causing the shifting of the midline structures to the contralateral side. The giant cyst was successfully removed without rupture. The possibility of infection with Echinococcus gramilosus should be included in the differential diagnosis of unspecific neurologic symptoms such as a progressively worsening headache, especially in pediatric patients from the geographic areas in which that parasite is endemic.Öğe Resolution of a fourth ventricle epithelial cyst after ventriculoperitoneal shunting(Elsevier Science Inc, 2007) Tatli, Mehmet; Guzel, Aslan; Kilincer, Cumhur; Sav, AydinBackground: Symptomatic cysts of epithelial origin occurring in the fourth ventricle are very rare. When such a cyst is encountered, the treatment strategy includes surgical removal or fenestration of the cyst into subarachnoid space. Case 1: A 23-year-old male was diagnosed as having a cyst located in the fourth ventricle causing hydrocephalus; the patient underwent cyst removal via craniotomy. The histopathologic diagnosis was neuroepithelial cyst. Because clinical and neuroradiological findings persisted, he underwent VP shunting. The cyst disappeared and did not recur. Case 2: A 54-year-old woman was diagnosed as having a cystic mass in the fourth ventricle and dilatation of the ventricles. Magnetic resonance imaging showed the same findings as those of the first case. The patient refused craniotomy for total mass excision. Therefore, a VP shunt was applied. Postoperatively, the clinical findings and hydrocephalus improved, and complete disappearance of the cystic mass was observed unexpectedly. Both cases had 2 years of follow-up. Conclusion: There is no proven mechanism to explain resolution of fourth ventricle cysts after a supratentorial VP shunting. We hypothesize that disappearance of the cyst could result from rupture of its wall because of pressure gradient, which might be facilitated by a VP shunt. The current report should not be taken as an argument against cyst removal, which is the established way of treatment. However, considering that the pathogenesis and pathophysiology of these cysts are unclear, VP shunting should be considered especially for recurrent cases accompanied by hydrocephalus. (c) 2007 Elsevier Inc. All rights reserved.Öğe Serum neuron-specific enolase as a predictor of short-term outcome and its correlation with Glasgow Coma Scale in traumatic brain injury(Springer, 2008) Guzel, Aslan; Er, Uygur; Tatli, Mehmet; Aluclu, Ufuk; Ozkan, Umit; Duzenli, Yucel; Satici, OmerElevated serum neuron-specific enolase levels are correlated with brain cell damage. Low scores according to Glasgow Coma Scale are also considered as serious poor prognostic factor. The aims of the study were to investigate whether there is a correlation between the two measurements in patients with traumatic brain injury and whether serum neuron-specific enolase levels have potential as a screening test to predict outcome. A total of 169 consecutive patients with traumatic brain injury admitted to our clinic between 2002 and 2005 are included in this study. Those patients, who had any major health problem before trauma, were excluded from the study. However, patients with isolated head injury were included in the study. Serial serum neuron-specific enolase concentrations taken at the first 2, 24, and 48 h after traumatic brain injury were analyzed. A computed tomography was performed on each patient on admission. Their Glasgow Coma Scale scores were recorded serially. The relationship between Glasgow Coma Scale scores and the serum neuron-specific enolase levels were assessed by statistical methods. There was a significant negative correlation between the serum neuron-specific enolase levels and Glasgow Coma Scale scores. The levels of neuron-specific enolase were significantly higher in the patients who died in 30 days after trauma and whose scores were lower than or equal to 8 points in Glasgow Coma Scale. Although there are several serious limitations of the use of neuron-specific enolase as a biomarker in traumatic brain injury (i.e., hypoperfusion, extracranial trauma, bleeding, liver, or kidney damage also increase the level of neuron-specific enolase), its concentrations may be useful as a practical and helpful screening test to identify neurotrauma patients who are at increased risk and may provide supplementary estimation with radiological and clinical findings.
