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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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    Orbital tumors: An analysis of fourteen cases
    (2018) Millet, Hakan; Istemen, Ismail; Gezercan, Yurdal; Afser, Kemal Alper; Okten, Ali Ihsan
    Aim: Orbital tumors are rarely seen in neurosurgery practice. They have quite variable clinical results, and are often reported in the literature as a series in relation to the patient’s age, geographical factors, and whether they were treated at neurosurgery or ophthalmology clinics. In our study, we evaluated the pathological results, demographic characteristics, and clinical results of patients who had undergone surgery for orbital tumors in our clinic. Material and Methods: Fourteen patients who were operated on between 2012 and 2017 at the Adana City Training and Research Hospital were investigated in this study. The patient files and radiological investigations were evaluated retrospectively, and the patients were followed up for 22 months (min-max: 14-28 months) ona verage. The patients were evaluated in terms of their admission complaints, preoperative and postoperative neurological examination findings, surgical approaches, pathologic results, and complications. Results: Eight patients (57%) were females, 6 (43%) were males, and their average age was 49.4 years old (min-max:19-86). The most common admission complaint was swelling around the eye, which was observed in 12 (85%) of the patients. The computed tomography and magnetic resonance imaging scans of all of the patients were investigated before their operations. The masses were removed from 5 (35%) patients with lesions located in the anterior and lateral areas using a lateral canthotomy technique. A fronto-orbital zygomaticapproachwas preferred for5 (35%) patients with intracranial extensions of the tumors toward the temporal fossa or frontal region. A fronto-orbitalapproach was preferred in 4 (28%) of the patients with tumor locations in the posterior and medial chambers. The masses were totally removed in 11 (79%) of the patients and subtotally removed in 3 (21%) patients. Conclusion: Overall, orbital masses are rarely observed, and their pathological profiles vary according to the patient’s age, geographical region, and location. Different approaches may be preferred during surgical removal; however, the overall purpose is to remove the mass without leading to neural and cosmetic complications
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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.