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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 Assessment of Cases With Intracranial Hydatid Cyst: A 23-Year Experience(Journal Neurological Sciences, 2014) Turan, Yahya; Yilmaz, Tevfik; Gocmez, Cuneyt; Kamasak, Kagan; Kemaloglu, Serdar; Tekin, Recep; Hattapoglu, SalihObjective: 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 Co-occurrence of lumbar spondylolysis and lumbar disc herniation with lumbosacral nerve root anomaly(Medknow Publications & Media Pvt Ltd, 2014) Yilmaz, Tevfik; Turan, Yahya; Gulsen, Ismail; Dalbayrak, SedatLumbosacral nerve root anomalies are the leading cause of lumbar surgery failures. Although co-occurrence of lumbar spondylolysis and disc herniation is common, it is very rare to observe that a nerve root anomaly accompanies these lesions. A 49-year-old male patient presented with sudden-onset right leg pain. Examinations revealed L5/S1 lumbar spondylolysis and disc herniation. At preoperative period, he was also diagnosed with lumbosacral root anomaly. Following discectomy and root decompression, stabilization was performed. The complaints of the patient diagnosed with lumbosacral root anomaly at intraoperative period were improved at postoperative period. It should be remembered that in patients with lumbar disc herniation and spondylolysis, lumbar root anomalies may coexist when clinical and neurological picture is severe. Preoperative and perioperative assessments should be made meticulously to prevent neurological injury.Öğe Comparison of ependymomas and medulloblastomas located in the posterior cranial fossa: An anatomical and histopathological study(Pisa University Press, 2020) Yılmaz, Tevfik; Öztürk, Pınar Aydın; Başar, İbrahim; Turan, Yahya; Aslanoğlu, Barış; Aydın, Kamuran; İbiloğlu, İbrahim; Tuncer, Mehmet CudiPURPOSE: Posterior fossa tumors (PFTs) include medulloblastomas, atypical teratoid/rhabdoid tumors, pilocytic astrocytomas, ependymomas, and brainstem gliomas. We evaluated patients with surgery at our clinic, comparing epidemiological, clinical, radiological, and pathological characteristics of medulloblastoma and ependymoma to identify factors that might assist preoperative diagnosis, help to develop treatment algorithms, and have prognostic value after surgery. METHODS: Pediatric patients from 0 to 16 and young adults from 16 to 29 years of age with surgery for pathologically confirmed ependymomas or medulloblastomas between January 2014 and January 2020 were eligible. The study included 19 patients, seven with ependymoma (37%) and 12 with medulloblastoma (63.2%). The ependymoma patients were 5.29 +/- 5.85 years of age, the medulloblastoma patients were 11.58 +/- 8.17 years of age, and 16 patients (84%) were children. RESULTS: Fifteen patients (79%) presented with signs of increased intracranial pressure and four (21%) presented with cerebellar findings. MRI found that 74% (14) of the PSTs were located in the midline, including six of the seven ependymomas (86%) and eight of the 12 medulloblastomas (67%). Enhancement was significantly greater in medulloblastomas compared with ependymomas (p = 0.022). In according to pathology results; synaptophysin, NSE, chromogranin and 50% GFAP positivity were observed in medulloblastoma. Ependymomas were S100 (43%) and vimentin (29%) positive. Ependymoma patients were younger than medulloblastoma patients and more were female. Conclusions: There were no significant differences in the clinical findings, but ependymomas were larger and had greater rates of enhancement and spinal metastasis compared with medulloblastomas.Öğe Cranially migrated lumbar intervertebral disc herniations: A multicenter analysis with long-term outcome(Wolters Kluwer Medknow Publications, 2019) Özturk, Sait; Çakın, Hakan; Demir, Fatih; Albayrak, Serdal; Akgün, Bekir; Turan, Yahya; Erol, Fatih Serhat; Kaplan, MetinObjective: Risk factors of cranial migration were investigated in patients with lumbar disc herniation (LDH) that migrated in the cranial direction and the long-term outcomes are discussed in this study. Materials and Methods: Patients who underwent surgery for LDH at four different centers between 2012 and 2017 were studied. Extraligamentous discs were located in the lateral part of the posterior longitudinal ligament (PLL) within the spinal canal of the axial plane, and subligamentous discs were located under the PLL. The extent of cranial migration was calculated as a percentage of the height of the migrated corpus. Based on the extent of cranial migration, partial hemilaminectomy or hemilaminectomy was performed at different rates in each patient and the amount of laminectomy performed was recorded. During surgery, all free fragments were attempted to be removed. The appropriate technique was decided intraoperatively, and the surgery was performed on an individual patient basis. Results: Of 1289 patients who underwent surgery for LDH, 654 (50.73%) had caudal migration, 576 (44.68%) had migration at the level of the disc, and 59 (4.57%) had cranial migration. Analysis of 59 patients with cranial migration according to the localization of the disc fragment revealed that 31 had extraligamentous and 28 had subligamentous fragments (P = 0.024). Conclusions: Extraligamentous intervertebral disc fragments migrate more cranially than subligamentous intervertebral fragments. The anatomy of the PLL that varies along the corpus is the main reason for the weakness of the resistance of the disc material to the dorsolateral region, direction of discrete force vectors, and orientation of the disc fragment due to torsional vertebral movements.Öğe The effectiveness of transforaminal epidural steroid injections on radicular pain, functionality, psychological status and sleep quality in patients with lumbar disc herniation(Ios Press, 2017) Sariyildiz, Mustafa Akif; Batmaz, Ibrahim; Yazmalar, Levent; Gunes, Mehmet; Turan, YahyaBACKGROUND: The significance of fluoroscopy-guided transforaminal epidural steroid injections (TFESI) in the treatment of lumbar disc herniation (LDH) is well known. The aim of our study is to investigate the effectiveness of TFESI on radicular pain, functionality, psychological status, and sleep quality in patients with LDH. METHODS: Seventy-five LDH patients (36 males, 39 females) were enrolled in the study. All patients received a fluoroscopically guided TFESI (betamethasone 40 mg, lidocaine 2%). Also all patients were evaluated according to (with the visual analogue scale) radicular pain, Oswestry disability index (ODI), hospital axiety and depression scale, and Pittsburgh sleep quality index (PSQI) at baseline, at two weeks, and 12 months post injections. RESULTS: Mean age was 46.4 +/- 12.5. When compared to baseline measurements there were significant improvements in radicular pain, ODI, modified schober, Laseque angle, finger to floor distance, depressive symptoms and PSQI scores at two weeks and 12 months after injection. Improvement of at least 50% in radicular pain relief, ODI score and sleep quality index was detected at two weeks 83%, 71%, 69% respectively. This rate showed regression at 12 months of 73%, 65% and 62% respectively. Duration of symptoms was significantly negatively correlated with changes in scores of radicular pain, ODI, depressive symptoms, and PSQI. There were no significant correlations with symptom duration and anxious symptoms. CONCLUSION: Fluoroscopy guided TFESI had positive effects on radicular pain, functionality, depressive symptoms and sleep quality in management of LDH.Öğe Efficacy of dexamethasone on penicillin-induced epileptiform activity in rats: An electrophysiological study(Elsevier Science Bv, 2014) Yilmaz, Tevfik; Akca, Metehan; Turan, Yahya; Ocak, Hakan; Kamasak, Kagan; Yildirim, MehmetCorticosteroids are extensively used in treatment of many diseases. In neurosurgery practice, dexamethasone (DEX) is commonly used particularly in cerebral edema secondary to brain tumors, head trauma, and central nervous system infections. There are some uncertainties surrounding the secure use of DEX in patients with epilepsy or seizures induced by diseases of the central nervous system such as head trauma and brain tumors. Despite its extensive use, the effect of DEX on epileptiform activity is unclear. In this study the effect of DEX on epileptiform activity was investigated in rats. The effects of 1, 3, and 10 mg/kg DEX on epileptiform activity was compared with effects of antiepileptic drugs commonly employed in treatment of epilepsy, namely phenytoin (PHT) 50 mg/kg and levetiracetam (LEV) 50 mg/kg that were administered intraperitoneally for 1 week. All groups were administered intracortical penicillin (500 IU) to induce epileptiform activity. DEX at the doses of 3 mg/kg and 10 mg/kg significantly reduced spike frequencies compared to the initial values. In conclusion, we think that DEX can effectively decrease the epileptiform activity. (C) 2014 Elsevier B.V. All rights reserved.Öğe Evaluation of risk factors affecting hospital-acquired infections in the neurosurgery intensive care unit(Informa Healthcare, 2014) Gocmez, Cuneyt; Celik, Feyzi; Tekin, Recep; Kamasak, Kagan; Turan, Yahya; Palanci, Yilmaz; Bozkurt, FatmaThe aim of the present study was to identify nosocomial infections (NIs), and their associated risk factors, in patients treated in the neurosurgery intensive care unit (NICU) of our hospital. Patients determined to have NIs between January 2008 and December 2012 were included in the study. Each patient's age, gender, microbiological culture results, underlying conditions, type of NIs, device utilization, total parenteral nutrition, reason for hospitalization, Glasgow score, and treatment were recorded and evaluated using statistical analysis. Risk factors for NIs were analyzed with a logistic regression model. During the five-year period, 60 NI episodes were detected in 56 out of 1643 patients. The mean age of the patient population was 33.3 (1-79) years. Of the patients, 22 were female and 34 were male. The overall incidence rate (NIs/100) and incidence density (NIs /1000 days of stay) of NIs were 3.65% and 6.5/1000 patient days, respectively. Regardless of the year of surveillance, the three most commonly detected NIs were bloodstream infection, shunt infection, and ventilator-associated pneumonia. No statistically significant difference was detected between infected and uninfected patients in terms of sex, age, blood transfusions, or mannitol and steroid use (p >= 0.05). In the present study, Glasgow scores, the frequency of prior usage of broad-spectrum antibiotics, and NICU stay durations were significantly higher among patients with infections (p < 0.001). Univariate analysis demonstrated that a low Glasgow score, re-operation, and use of mechanical ventilation were risk factors for NIs. We identified low Glasgow coma scores, long hospital stay duration, use of wide spectrum antibiotics, mechanical ventilation, total parenteral nutrition, and re-operation as risk factors for NIs.Öğe İdrar inkontinansı ile birlikte lomber intraspinal sinovyal kist: Olgu sunumu ve literatür incelemesi(2013) Yılmaz, Tevfik; Kamaşak, Kağan; Hattapoğlu, Salih; Ceviz, Adnan; Turan, Yahya; Gocmez, CüneytSinovyal kistler epidural kompresif sendromları olan olgu-larda nadiren görülmektedir. Radiküler semptomlarla diskhernilerini taklit edebilen intraspinal lezyonlardır. Yirmi se-kiz yaşında bayan hasta, altı aydır süren bel ağrısı, biraydır idrar kaçırma ve son iki haftadır giderek artan sağ bacak ağrısı ve uyuşma gibi radiküler şikayetlerle baş-vurdu. Fizik muayenesinde; gastrokinemius kasında güçkaybı (4/5), sağ L5,S1 hipoestezisi ve idrar inkontinansı tespit edildi. Manyetik rezonans görüntülemede, L5-S1 seviyesinde intraspinal kist görüldü. Olguya bilateral L5hemiparsiyel laminektomi, foraminotomi ve kist eksizyonuyapıldı. Hastanın özellikle idrar inkontinansı olmak üze- re postoperatif erken dönemde şikayetleri geriledi, bir yıl sonraki kontrol muayenesinde hiç bir şikayetinin olmadığı, motor ve duyu kaybının da tamamen düzeldiği gözlendi.Öğe The impact of the stage and tumor size on brain metastasis of cervical cancer.(Amer Soc Clinical Oncology, 2015) Teke, Fatma; Tunc, Senem Yaman; Teke, Memik; Turan, Yahya; Urakci, Zuhat; Altin, Suleyman; Eren, Bekir[Abstract Not Available]Öğe The impact of the stage and tumor size on rare brain metastasis of cervical cancer(Turkish Neurosurgical Soc, 2016) Teke, Fatma; Tunç, Senem Yaman; Teke, Memik; Turan, Yahya; Urakçı, Zuhat; Eren, Bekir; Altın, SüleymanAIM: To investigate the clinical features, prognostic factors and survival times of cervical cancer patients with brain metastasis. MATERIAL and METHODS: We retrospectively reviewed the medical records of 820 patients with cervical cancer. Data were analyzed using SPSS version 12.0 statistical software (SPSS, Chicago, IL, USA). Overall survival, time interval from diagnosis of cervical cancer to identification of brain metastasis, and median survival time after diagnosis of brain metastasis were calculated using Kaplan-Meier curve analysis. The log-rank test was used to compare differences in survival. Differences were assumed statistically significant when p-values were <0.05. RESULTS: The incidence of brain metastases from cervical cancer in our institution was 1.82% (15/820) over a ten-year period. The median time interval from diagnosis of cervical cancer to detection of brain metastasis was 12.5 months (range: 2.9-91.9 months). Stage and tumor diameter were found to be significant relating to the interval from diagnosis of cervical cancer to detection of brain metastasis (p=0.001 for both). CONCLUSION: This study provides much information about the prognosis of patients with brain metastases from cervical cancer and highlights the importance of initial stage and tumor diameter when determining the time interval until development of brain metastasis.Öğe İntrakranial menenjioma olgularının değerlendirilmesi: 72 hastanın analizi(Dicle Üniversitesi Tıp Fakültesi, 2018) Turan, Yahya; Yılmaz, TevfikAmaç: Kliniğimizde 2012–2018 yıllarında ameliyat olmuş ve menenjiom tanısı almış olan 72 hasta retrospektif olarak klinik, radyolojik ve patolojik bulgularıyla incelenerek literatür eşliğinde tartışıldı. Yöntemler: Hastaların yaşları, cinsiyetleri, klinik bulguları, radyolojik görüntüleri, yerleşim yerleri, ameliyat kayıtları ve patolojik olarak aldıkları tanıları incelendi. Bulgular: 72 intrakranial menenjiomalı hastanın 47 (%65,3)’i kadın, 25 (%34,7)’i erkektir. Kadın/Erkek oranı: 1.88’dir. Olgular 19-78 yaş aralığında olup, yaş ortalaması 44.7’dir. Sıklık sırasına göre başvurma nedenleri ve nörolojik muayene bulguları: Baş ağrısı (%72,2), bulantı-kusma (%37,5), epilepsi (%25,0), motor defisit (%20,8)’dir. En sık yerleştikleri lokalizasyonlar: konvexite 17 (%23,7), parasagital 14 (%19,5), sfenoid kanat 9 (%12,59 bölgesidir. Cerrahi tedavideki rezeksiyonumuzun Simpson klasifikasyonuna göre; hastaların 57 (%79,2)’i grade I, 8 (%11,1)’i grade II, 2 (%2,8)’i grade III, 4 (%5,5)’i grade IV ve 1 (%1,4)’i grade V olarak değerlendirilmiştir. Histopatojik tanıları ise sıklık sırasına göre; 29 (%40,3) meningotelyomatöz, 13 (%18,1) fibröz, 9 (%12,5) transisyonel, 6 (%8,3) oranında psammomatöz tip şeklinde tespit edildi. Sonuç: İntrakranial enenjiomalar malign tipleri dışında; genellikle benign karekterde yavaş büyüyen, erken tanı konup, total çıkarıldığında tam kür sağlanan, rekürrens oranı çok düşük olan tümörlerdir. Menenjiomalarda cerrahi kararın verilmesinde ve sürvide; hastaların yaşı, preoperatif performans skalası, tümörün lokalizasyonu, büyüklüğü, rezeksiyon derecesi, histopatolojik özellikleri gibi birçok faktör rol oynamaktadır. Asemptomatik, küçük boyutta, ameliyata uygun olmayan, yaşlı, kafa tabanı, kavernöz sinüs gibi ulaşılması zor lokalizasyonlarda bulunan hastalarda seri görüntülemelerle yakın takip ve radyocerrahi tercih edilebilir. MRG takibi 3. ay, 6. ay ve sonrasında yıllık takipler şeklinde ve takipte gerek görülürse, büyüme olursa cerrahi/radyocerrahi önerilir. Genç olan ve kalsifikasyonu bulunmayanlarda hızlı büyüme riski nedeniyle cerrahi düşünülmelidir.Öğe 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 Local Tissue Electrical Resistances in Transpedicular Screw Application in the Thoracolumbar Region(Turkish Neurosurgical Soc, 2016) Turan, Yahya; Sayin, Murat; Yurt, Alaattin; Yilmaz, Tevfik; Demircivi Ozer, Fusun; Temiz, CuneytAIM: To determine local tissue electrical resistance differences generated during a screw pass from the pedicle to another tissue rather than determining all individual electrical tissue resistance values. MATERIAL and METHODS: We attempted to measure electrical resistance values of regional tissues in addition to fluoroscopic imaging during application of fixation via a transpedicular screw. We also attempted to detect local tissue electrical resistance alterations in case of malposition of the screw inside the pedicle. For this purpose, local tissue electrical resistances of 10 transpedicular tracks opened with standard track openers bilaterally in 5 vertebrae, and of spinal cord accessed by puncturing the medial walls of three vertebrae in a cadaver were measured. These resistance differences were not only measured in human cadaveric tissue but also in 36 pedicles belonging to a total of 18 vertebrae between Th 1-S1 vertebrae of a sheep cadaver. Both medial and lateral walls were drilled to measure local tissue resistance differences in a sheep cadaver. RESULTS: Our results indicated that local tissue electrical resistance changes were statistically significant in both human and sheep cadaver. CONCLUSION: It is possible to prevent screw malposition using a simple and cheap electrical resistance measurement. Local tissue electrical resistance measurement during transpedicular screw insertion is a safe, simple, cheap, and practical method.Öğe A Modified Technique for the Treatment of Isthmic Spondylolisthesis(Turkish Neurosurgical Soc, 2015) Yilmaz, Tevfik; Dalbayrak, Sedat; Yaman, Onur; Yilmaz, Mesut; Ayten, Murat; Turan, Yahya; Ozturk, KadirAIM: To describe a modified technique for the treatment of single level, isthnnic spondylolisthesis (IS) MATERIAL and METHODS: Forty-two patients who underwent posterior lumbar interbody fusion (PLIF) with spinolaminar autologous bone graft for the treatment of isthmic spondylolisthesis between May 2007 and November 2011, were retrospectively reviewed. All patients underwent total removal of the spinolaminar process, total discectomy and endplate decortication, and proper size spinolaminar autologous bone graft was sequentially inserted into the disc space with posterior instrumentation. Outcomes of the study included visual analogue scale (VAS), Oswestry disability index (ODI), and radiographic fusion. RESULTS: The average duration of follow-up was 3.5 years. Neither has implant failure been observed nor has revision been required so far.The mean Oswestry Disability Index improved from 53% to 9.5%, and visual analog scale for back pain from 8.5 to 3.8 at the first month and 1.3 at the sixth month postoperatively. Visual analog scale for leg pain from 8.3 to 1.4 at the first month and 0.8 at the sixth month postoperatively. All patients had clinical and radiographic evidence of solid fusion without any need for revision. CONCLUSION: The modified posterior lumbar interbody fusion and posterior instrumentation technique is a safe and effective treatment for isthmic spondylolisthesis.Öğe Pathophysiology of the spinal cord injury(Modestum Ltd., 2014) Yılmaz, Tevfik; Turan, Yahya; Keleş, AyşenurOmurilik yaralanması toplumsal düzeyde problemlere yol açan morbidite ve mortalitenin önemli nedenlerindendir.Günümüze kadar pek çok çalışma yapılmasına rağmen evresel tedavi protokolü geliştirilememiştir. Omurilik yaralanmalarının tedavisinde çalışmalar iki mekanizma üzerine yoğunlaşmıştır. Birincisi hasar görmüş omuriliği koruyucu nöroprotektif ajanların kullanılması diğeri hasarlanmış omurilikte aksonların fonksiyonlarını kazanabilecekleri rejenerasyon çalışmalarıdır. Etkin tedavinin bulunabilmesi için omurilik yaralanması sonrası patofizyolojik değişiklikler iyi bilinmelidir.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 Posterior Epidural Migration of a Sequestered Lumbar Intervertebral Disc Fragment(2017) Sarıyıldız, Mustafa Akif; Özevren, Hüseyin; Turan, Yahya; Yılmaz, Tevfik; Teke, Memik; Temiz, Cüneyt; Gocmez, 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 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.
