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    Colloid cyst of the third ventricle: A clinical series of 19-cases
    (2017) Bilgin, Emre; Cavus, Gokhan; Acik, Vedat; Arslan, Ali; Yalman, Celil; Okten, Ali Ihsan
    Aim: Colloid cysts are benign tumors originating from primitive neuroepithelial or endodermic origin in the third ventricle. Asymptomatic, as well as paroxysmal headache, gait disturbance, nausea, vomiting, learning difficulty and death may occur. Computed tomography (CT) is also seen as a round or oval, non-contrasting lesion. Magnetic resonance imaging (MRI) also shows hyperintense at T1 weighed and isointens at T2 weighed sequences. Stereotactic aspiration, microscopic or endoscopic approaches, shunt can be applied. Total excision should be targeted.Materials and Methods: We aimed to investigate the age, sex, complaint, hydrocephalus presence, neurological examination findings, surgical method and results of 19 cases of colloid cyst in our clinic between 2012-2017.Results: Eleven of 19 cases were female (57.9%) and 8 were male (42.1%).The average age was 27.2 (2-62). The most common complaint was headache. Ptosis due to visual disturbance was seen in 5.3% (1 patient), ataxia in 10.5% (2 patients), hydrocephalus with memory loss in 31.5% (6 patients). Six patients underwent cystectomy with endoscopic third ventriculostomy (ETV) and transcranial surgery in 13 patients. Ventriculoperitoneal shunt was performed to one patient at eight months after surgery. Rhinorrhea and menengitis was seen in one patient. Medical theraphy was given to this patient. One patient died because of acute cerebral anfarct.Conclusion: Asymptomatic old patients must be followed periodically. Symptomatic patients must be treated surgıcally and it must be combined by V-P shunt if patients had hydrocephalus. One of the surgıcal endoscopic or transcranial technique can be selected. Transcortical or interhemispheric techniques may be preferred to transcranial techniques.Keywords: Colloid Cyst; Total Resection; Hydrocephalus; Endoscopic Third Ventriculostomy.
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    Intradural Extramedullary Nerve Sheath Tumors: 37 Cases Clinical Series
    (2017) Gezercan, Yurdal; Bilgin, Emre; Cavus, Gokhan; Acik, Vedat; Okten, Ali Ihsan
    Aim: The nerve sheaths are generally called as schwannomas and they are developed from dorsal nerve roots. They form 25% of the intradural tumors. They are observed more frequently in 4th and 5th decades. They are generally intradural however 20% of them develop as dumbbell shaped and become intradural-extradural components. The treatments of them are laminectomy or laminoplasty and total excision. Materials and Methods: 37 spinal schwannoma cases operated in our clinic between the years of 2005-2015 and are investigated in our study in terms of age, sex, complaint, duration of complaints, radiological localizations, neurological examination findings, relation with the dura, surgical method implemented and the effects of these parameters on the clinical course. Results: 19 of 37 cases were males (51.4%), 18 were females (48.6%). Age average was 44.9 (20-79). The most frequent complaint was pain (72.9%) and weakness and numbness in the legs. They had lumbar (59.5%), thoracic (24.3%), cervical (16.2%) localizations. 18.9% of the cases revealed extraforaminal extension to abdomen or thorax in the shape of dumbbell. 80% total mass excision was provided by performing 80% laminectomy and 20% laminoplasty for the patients. 3 CSF (Cerebrospinal fluid) leakage, 2 superficial infection, 1 meningitis, 3 temporary neurological deficit and 1 permanent neurological deficit developed as postop complication. Conclusion: Nerve sheath tumors are the most frequent type of intradural extramedullary tumors and they have benign characteristics. They absolutely provide good results in early diagnosis, early period surgery, without extraforaminal extension and in total resection
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    Morphometric MRI assessment of lumbar region in healthy individuals
    (2020) Istemen, Ismail; Olguner, Semih Kivanc; Arslan, Ali; Acik, Vedat
    Aim: In our study, we aimed to obtain normal anatomical data in healthy individuals by magnetic resonance imaging, which we frequently use in our daily practice. We encounter quite frequently with the lumbar pathologies. To identify the pathological one, the normal one must first be defined. For this, anatomical studies are the most ideal methods, but costly and challenging studies. Morphometric assessment of the lumbar region by magnetic resonance imaging in the normal population is not common in the literature.Material and Methods: The workup of 100 patients who presented to our clinic, did not have low back pain, underwent lumbar MRI examination for different reasons and whose results were reported to be normal, were evaluated using the PACS system. Morphological evaluation of the paravertebral muscles, ligamentum flavum, and the spinal canal was performed on the right and left sides separately. The data were analyzed by age, gender, and body mass index.Results: Forty-nine patients were females, and 51 were males. The mean age of the patient group was 34.62±9.54 years, and mean BMI was 24.96±3.32 kg/m2. Ligamentum flavum thickness and muscle areal measurements were similar between both sides. The comparisons of clinical measurements between females and males revealed that the areas of muscles were significantly higher among males and all other measurements were similar between sexes. There was a weak and positive correlation between age and both right and left erector spinae area. The only parameters that weakly and positively correlated with body mass index were right and left erector spinae areas.Conclusion: In our study, we reported the morphological characteristics of the lumbar region in healthy individuals. An increase in the cross-sectional areas of the erector spinae and the spinal canal at the L5-S1 level was observed with the age. An asymmetry may develop in LF measurements with the age. There was also a positive correlation between body mass index and the cross-sectional area of erector spinae.
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    Spinal dermoid and epidermoid tumors: Clinical series of 15 cases
    (2018) Cavus, Gokhan; Istemen, Ismail; Acik, Vedat; Bilgin, Emre; Arslan, Ali; Millet, Hakan; Gezercan, Yurdal; Okten, Ali Ihsan
    Aim: Dermoid tumors are benign tumors originating from ectopic ectoderm and mesoderm remnants in the spinal tract. The congenital epidermoid cyst is considered to be developed as a result of ectodermal tissue inclusion during primitive neural tube enclosure. The aim of this study is to share our surgical results of spinal dermoid and epidermoid tumor cases performed in our clinic. Material and Methods: 8 (53.3%) dermoid tumor and 7 (46.7%) epidermoid cases, which have been operated at our clinic between 2010 and 2015, were assessed retrospectively. Results: 5 females (33.3%) and 10 males (66.7%) patients are included with an average age of 16.7 (1-43). The mass of 1 patient (6.7%) was cervical, 3 (20%) were thoracic, and 11 (73.3%) were lumber region located. One patient (6.7%), operated 7 years before at an outer site, applied for relapse in the lumbar region. Two patients (13.3%) had a dermal sinus tract. Three patients (20%) paraplegia and 4 patients (26.7%) had paraparesis preoperatively. Patients were evaluated using X-ray, spinal CT and spinal MRI tests. 3 patients (20%) with paraplegia were operated in emergency conditions. Intraoperative neuromonitorisation was performed. They were excised in 13 patients (86.7%) in total and 2 patients in subtotal. Two patients’ (13.3%) paraplegia improved in early period controls. No change occurred in 1 patient (6.7%). Four patients’ paralysisimproved (26.7%). One patient developed wound site infection (6.7%). Conclusion: Dermoid tumors are rare benign congenital lesions. The purpose of the treatment is to excise the mass as total as possible without destructing the capsule. Subtotal excision is recommended rather the forming a neurological deficit.
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    Surgical approach and treatment outcomes for the rare giant aneurysms: 3 Cases
    (2017) Gezercan, Yurdal; Acik, Vedat; Cavus, Gokhan; Bilgin, Emre; Istemen, Ismail; Okten, Ali Ihsan
    Aim: Giant aneurysms are used to describe aneurysms over 25 mm.They are rarely seen cases within all aneurysms and usually present with rupture at an early age or mass effect at an older age. We aimed to describe the methods that can be applied in the diagnosis and treatment of giant aneurysms and the points to be considered. Materials and Methods: Three patients, two males and one female, who were admitted to our clinic between 2015-2016 with different clinical findings and whose giant aneurysms were detected in their examinations, were discussed. Computed Tomography (CT), Digital Subtraction Angiography (DSA), Magnetic Resonance Imaging (MRI) were performed on the patients.Subarachnoid hemorrhage (SAH) presence, the size of the aneurysms, whether they were thrombosed or calcific, their localizations, compression occurred in neural structures of the patients were evaluated. Results: One patient applied to the emergency department due to SAH.One patient had frontal lobe findings and one patient had headache.Giant aneurysms including left M1 in the level of the right middle cerebral artery (MCA) bifurcation in 2 of the patients and in the level of left internal carotid artery bifurcation in one of the patients.2 patients underwent operations and one was led to endovascular treatment. Conclusion: Aneurysms may grow as big as to cause compression effect before being ruptured. Performing MRI,CT,DSA in the patients with giant aneurysms are critical in terms of leading the treatment.In particular, DSA investigation to be performed in detail is very valuable in terms of leading the patient to surgical and endovascular treatment and determining the strategy of the surgery and the endovascular treatment to be applied.