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    The Contribution of Cervical Dynamic Magnetic Resonance Imaging to the Surgical Treatment of Cervical Spondylotic Myelopathy
    (Turkish Neurosurgical Soc, 2015) Dalbayrak, Sedat; Yaman, Onur; Firidin, Mustafa Nevzat; Yilmaz, Tevfik; Yilmaz, Mesut
    AIM: Cervical spine is the most kinetic segment of the whole vertebrae. The radiologic imaging methods concern with the morphologic changes but give no functional data. At flexion, spinal cord strains, anterior osteophytic compression increases. At extension, spinal canal gets narrower, cord shortens and gets thicker, compression of posterior ligament gets abberant and cord compression increases. MATERIAL and METHODS: 258 cervical spondylotic myelopathy (CSM) cases were scanned by conventional magnetic resonance imaging (MRI) and additionally dynamic MRI. Contributions of dynamic cervical MRI to the surgical plans and results were evaluated. RESULTS: We had sagittal and axial T2W MR scans at flexion and extension, in addition to the neutral cervical MR imaging. We found that the AP diameter of spinal canal is increased 14.9% in flexion and decreased 13.4% in extension relative to the neutral MR imaging. CONCLUSION: The changes of the cord compression and the transvers area of cord which is the most important prognostic indicator in spinal diseases and also the area of spinal cord and subarachnoid space can be detected via dynamic axial sections of MRI. Dynamic MR images may be helpfull in the decision making for the surgical treatment of CSM.
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    Miliary tuberculosis Epidemiologicaland clinical analysis of large-case series from moderate to low tuberculosis endemic Country
    (Lippincott Williams & Wilkins, 2017) Mert, Ali; Arslan, Ferhat; Kuyucu, Tulin; Koc, Emine Nur; Yilmaz, Mesut; Turan, Demet; Altin, Sedat
    The aim of this study was to determine the clinical features, and outcome of the patients with miliary tuberculosis (TB). We retrospectively evaluated 263 patients (142 male, 121 female, mean age: 44 years, range: 16-89 years) with miliary TB. Criteria for the diagnosis of miliary TB were at least one of the followings in the presence of clinical presentation suggestive of miliary TB such as prolonged fever, night sweats, anorexia, weight loss: radiologic criterion and pathological criterion and/or microbiological criterion; pathological criterion and/or microbiological criterion. The miliary pattern was seen in 88% of the patients. Predisposing factors were found in 41% of the patients. Most frequent clinical features and laboratory findings were fever (100%), fatigue (91%), anorexia (85%), weight loss (66%), hepatomegaly (20%), splenomegaly (19%), choroid tubercules (8%), anemia (86%), pancytopenia (12%), and accelerated erythrocyte sedimentation rate (89%). Tuberculin skin test was positive in 29% of cases. Fifty percent of the patients met the criteria for fever of unknown origin. Acid-fast bacilli were demonstrated in 41% of patients (81/195), and cultures for Mycobacterium tuberculosis were positive in 51% (148/292) of tested specimens (predominantly sputum, CSF, and bronchial lavage). Blood cultures were positive in 20% (19/97). Granulomas in tissue samples of liver, lung, and bone marrow were present in 100% (21/21), 95% (18/19), and 82% (23/28), respectively. A total of 223 patients (85%) were given a quadruple anti-TB treatment. Forty-four (17%) patients died within 1 year after diagnosis established. Age, serum albumin, presence of military pattern, presence of mental changes, and hemoglobin concentration were found as independent predictors of mortality. Fever resolved within first 21 days in the majority (90%) of the cases. Miliary infiltrates on chest X-ray should raise the possibility of miliary TB especially in countries where TB is endemic. Although biopsy of the lungs and liver may have higher yield rate of organ involvement histopathologicaly, less invasive procedures including a bone marrow biopsy and blood cultures should be preferred owing to low complication rates.
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    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, Kadir
    AIM: 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.
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    Supraclavicular Surgical Approach for Thoracic Outlet Syndrome: 10 Years of Experience
    (Turkish Neurosurgical Soc, 2014) Dalbayrak, Sedat; Yaman, Onur; Yilmaz, Mesut; Yilmaz, Teyfik
    AIM: Symptoms of thoracic outlet syndrome (TOS) may be vascular, neurological or combined symptoms involving both. Treatment of TOS is generally conservative. Surgical treatment is required when radiological results indicate anatomical abnormality. This study aims to present the surgical outcomes of TOS patients treated with supraclavicular approach via microsurgery. MATERIAL and METHODS: 41 patients with thoracic outlet syndrome were rewieved retrospectively. The pain was determined using both on visual analogue scale (VAS) and Oswestry score both in the preoperative and postoperative period. All patients underwent electromyography including brachial plexus, ulnar and median nerves. Computed Tomography (CT) angiographic examination was applied dynamically with required manoeuvres. RESULTS: Post-op VAS scores were recorded as 0.8 for the arm, 0.6 for the shoulder and 0.5 for the neck, while pre-op VAS scores were 6.3 for the arm, 6.0 for the shoulder and 5.2 for the neck. Post-op Oswestry disability index (OD!) average was found as 14,2, while this figure was 67,4 during the pre-operative period. CONCLUSION: Accurate patient selection is imperative for increasing the success of TOS surgery. Microscopic TOS surgery yields satisfactory results with smaller incision, safer surgery and a lower rate of complication.
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    Treatment Principles for Coccygodynia
    (Turkish Neurosurgical Soc, 2014) Dalbayrak, Sedat; Yaman, Onur; Yilmaz, Tevfik; Yilmaz, Mesut
    AIM: An evaluation of treatment methods and outcomes for coccygodynia cases that do not respond to conservative treatment. MATERIAL and METHODS: Local anesthetic and steroid injections were applied in 32 coccygodynia cases that did not respond to conservative treatment (average of 15 months). Coccyx excision was performed as surgical treatment in 25 cases that had pain relief after the injections but later re-presented with complaints. The patients' pain levels were assessed with VAS. Postacchini classification was used for patient classification based on plain radiography. RESULTS: 20 (62%) of the cases (the total including injection and surgery groups) had a trauma history. Majority of the cases treated with local steroid injection included patients with Type I, while the 25 cases that received surgical treatment predominantly included Type II patients. One case had post-operative skin infection, which was treated with antibiotics. It was observed by comparing pre-operative and post-operative pain scores that both methods provided significant pain relief in all patients. CONCLUSION: While local steroid injection is an effective method of treatment for Type I patients, the coccyx removal I is an effective method for controlling the pain in patients with trauma history and in Type II, III and IV patients.