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Öğe An end plate chondroma mimicking calcified lumbar disc herniation -: A case report and review of the literature(Walter De Gruyter & Co, 1999) Erten, SF; Koçak, A; Mizrak, B; Kutlu, R; Çolak, AThe authors report a case of chondroma arising from a vertebral end-plate and mimicking lumbar disc herniation. This tumor became calcified within 2 weeks. It was completely removed surgically, after which the patient's symptoms were relieved and neurological deficits regressed.Öğe Gliofibroma(Sage Publications Ltd, 2004) Erguvan-Önal, R; Ates, O; Önal, C; Aydin, NE; Koçak, AAlthough gliofibroma is a rare and incompletely characterized tumor, recent publications have revealed new aspects of this entity. The case of a 16-year-old boy who was diagnosed as having a gliofibroma is presented here, and the problems regarding nosology are discussed in the light of the recent literature.Öğe Intracranial migrating bullet(Lippincott Williams & Wilkins, 2004) Koçak, A; Özer, MHRetained bullets and fragments following a civilian gunshot injury are quite frequent in practical neurosurgery. It is usually possible to extract the foreign body surgically, while rare cases are conservatively treated because of technical reasons. Conservative treatment may present complications, and a rare form of this presentation is migration of the bullet. A 20-year-old man presented with migrating bullet from a supratentorial to opposite infratentorial area. We consider that in the migrating bullet fragment cases, if there is no contraindication, the most reasonable treatment is its urgent surgical removal. This report reveals a supratentorial bullet migrating to the infratentorial contralateral area, and related literature considering the different mechanisms of migration is discussed.Öğe Intraventricular solitary fibrous tumor(Lippincott Williams & Wilkins, 2004) Koçak, A; Çayli, SR; Saraç, K; Aydin, NEOBJECTIVE AND IMPORTANCE: Intracranial solitary fibrous tumours, have described previously, but intraventricular solitary fibrous tumors are extremely rare. We present what is, to our knowledge, the first reported case of solitary fibrous tumor in the third ventricle. CLINICAL PRESENTATION: A 63-year-old man presented with weakness of his lower extremities and headaches. Computed tomography and magnetic resonance imaging of the brain revealed an enhancing mass in the posterior part of the third ventricle. INTERVENTION: The tumor originated from the wall of the left internal cerebral vein and extended to the posterior part of the third ventricle. Nearly total excision was performed via an infratentorial-supracerebellar approach. CONCLUSION: The differential diagnonis of intracranial solitary fibrous tumors includes fibroblastic meningioma, meningeal hemangiopericytoma, neurofibroma, and schwannoma. The differential diagnosis in the present case was greatly helped by the immunohistochemical and ultrastructural findings, along with a disease-free 3.5-year follow-up. These findings are presented with reference to previous.Öğe Is there a clinical correlate to the histological and radiological evidence of inflammation in trans-ligamentous extruded and sequestered lumbar disc herniaton?(Taylor & Francis Ltd, 2004) Çayli, SR; Koçak, A; Alkan, A; Kirimlioglu, HThe pain of lumbar disc herniation is related to direct compression of the nerve root and to the foreign-body inflammatory response to the herniated disc material. In this study, we attempted to identify disc-related inflammation in trans-ligamentous extruded and sequestered lumbar disc herniation using gadolinium-DPTA-enhanced T1-weighted and short-time inversion recovery ( STIR) magnetic resonance imaging. We assessed how these results related to each other, and to patients' clinical status, and to immunohistochemistry findings in disc specimens removed at surgery. Forty-one patients with transligamentous extruded or sequestered disc herniation were investigated clinically and radiologically. Twenty-five patients who did not respond to initial medical treatment or who had progressive neurological deficits underwent discectomy. Specimens of disc material removed during surgery were studied immunohistochemically and inflammatory cell types were identified. The other 16 patients showed good response to treatment, and were given further medical therapy and monitored for a mean of 6.3 months of follow-up. All radiological diagnoses in the operated cases were confirmed at surgery. There were no significant differences among the rates of detection of inflammation by contrast MRI, STIR technique, and immunohistochemistry in the surgical treated cases. In the medically treated cases, the frequency of radiological evidence of inflammation on the initial contrast enhanced T1-weighted and STIR images was similar to the frequency observed on the most recent scans done during follow-up. The study showed that the radiological and immunohistochemical evidence of inflammation in these cases does not correspond with patients' clinical pain profiles over time. It also revealed that STIR and contrast T1W are equally reliable for detecting inflammation in trans-ligamentous extruded or sequestered lumbar disc herniation. In future, studies that focus on physical and chemical mechanisms of pain in lumbar disc herniation in larger series of conservatively and surgically treated patients may clarify the link between inflammation and radicular pain in these types of disc herniation.Öğe Mature spinal teratoma associated with thickened filum terminale -: Case report(Japan Neurosurgical Soc, 2005) Ates, Ö; Çayli, SR; Koçak, A; Alkan, A; Önal, Ç; Usta, UA 30-year-old man presented with an intradural spinal teratoma with thickened filum terminale manifesting as urinary and sexual disturbances, and low back pain persisting for 4 years. Spinal magnetic resonance imaging revealed thickened filum terminale containing a heterogeneously enhanced intradural lesion extending from the L-3 to L-4 levels and in contact with the conus medullaris. The filum terminale was incised and the tumor was totally resected. The histological diagnosis was mature teratoma consisting of three germ cell layers. The patient's complaints had completely resolved 6 months later.Öğe Middle cerebral artery aneurysm associated with Behcet's disease -: Case report(Japan Neurosurgical Soc, 2004) Koçak, A; Çayli, SR; Ates, Ö; Saraç, KA 37-year-old man with Behcet's disease suffered secondary subarachnoid hemorrhage and intracerebral hematoma in the right temporal lobe caused by a ruptured aneurysm of the right middle cerebral artery. The aneurysm was successfully clipped. Aneurysm formation is common in the visceral arteries in Behcet's disease, but extremely rare in the intracranial arteries. Vasculitis may be involved in the etiology of intracranial aneurysms in patients with Behcet's disease.Öğe Potential salvage therapy for accidental intrathecal vincristine administration(Karger, 2000) Özgen, Ü; Soylu, H; Önal, SÇ; Mizrak, B; Türköz, Y; Kutlu, NO; Koçak, ABackground: Accidental intrathecal vincristine (VCR) administration results in severe neurotoxicity, usually fatal in outcome. No specific therapy for initrathecal VCR toxicity has been reported so far. In our recent report, complete in vitro degradation of VCR by hypochlorous acid (HOCl) was demonstrated. Methods: In this comparative study, we examined the in vivo effectivity of HOCl in the cerebrospinal fluid of 24 New Zealand rabbits following intracisternal VCR administration. Results: There were no significant clinical or histopathologic abnormalities in the control and HOCl groups; however, multiple necrotic foci on histopathological examination of brain sections in the VCR group were determined. There were significantly lower numbers of necrotic foci in brain sections of rabbits which received HOCl administration than those without therapy. Conclusion: Our results indicate that HOCl may reduce VCR neurotoxicity. Copyright (C) 2000 S. Karger AG, Basel.Öğe Spinal epidural abscess caused by brucellosis -: Two case reports(Japan Neurosurgical Soc, 2005) Ates, Ö; Çayli, SR; Koçak, A; Kutlu, R; Önal, RE; Tekiner, ABrucellosis is still an important public health problem in the Mediterranean countries, including Turkey, and is most probably underdiagnosed or underreported. Two rare cases of extradural brucellar granuloma causing spinal cord compression in the thoracic and cervical regions were identified by magnetic resonance imaging. The abscesses were totally excised surgically. Medical treatment was given immediately after diagnosis, but delayed neurosurgical intervention resulted in partial neurological recovery in one patient although the other showed complete neurological recovery. Abscess formation may cause myelopathy due to extradural compression of the spinal cord. Failure to correct this condition may cause irreversible impairment of motor functions. Magnetic resonance imaging should be performed periodically in patients with brucellosis and suspected vertebral involvement to monitor for epidural granuloma formation and prevent extradural cord compression.Öğe Spinal pneumorrhachis(Taylor & Francis Ltd, 2003) Çayli, SR; Koçak, A; Kutlu, R; Tekiner, AThe term pneumorrhachis refers to the presence of air in the spinal canal. There are only a few previously reported cases in the literature. A case of air within the cervical and lumbar subarachnoid spaces, and a second case of air within the cervical subarachnoid space due to traumatic pneumocephalus are presented in this study.Öğe An unusual complication of septorhinoplasty -: Massive subarachnoid hemorrhage(Lippincott Williams & Wilkins, 2004) Koçak, A; Gürlek, A; Kutlu, R; Celbis, O; Aydin, NESeptorhinoplasty is a very common operation in the practice of plastic surgery and otolaryngology. We report a case with massive subarachnoid hemorrhage originating from carotid artery injury, following corrective septorhinoplasty. The carotid rupture is a very rare but life-threatening, major complication of nasal surgery. Therefore, surgeons performing surgery in this area should be very careful and aware of this entity. According to our knowledge, this is the fourth case report of a carotid artery injury following septorhinoplasty, but it is the first bilateral and lethal one in the literature.Öğe An unusual presentation of neurotuberculosis(Amer Assoc Neurological Surgeons, 2001) Çayli, SR; Önal, Ç; Koçak, A; Onmus, SH; Tekiner, ATuberculosis continues to be a major public health concern, especially in developing countries. Many types of neurotuberculosis have been described, but there is only one previously reported case of subdural empyema caused by tuberculous bacilli. A 1-year-old boy who had been treated for pulmonary tuberculosis was referred to the authors' institution with a diagnosis of right frontoparietal extraaxial abscess formation. Computerized tomography and magnetic resonance imaging revealed an extraaxial abscess with no evidence of calvarial infection. A craniotomy was pet-formed to drain the pus, which was located subdurally. A polymerase chain reaction test yielded positive results, and histopathological examination revealed caseation. Antituberculous treatment was started after a diagnosis of subdural empyema with related neurotuberculosis had been made. At the end of a 12-month course of medical therapy, the patient was well with no evidence of tuberculosis.Öğe An unusual variant of a growing skull fracture in an adolescent(Karger, 1998) Çolak, A; Akbasak, A; Biliciler, B; Erten, SF; Koçak, AA great majority of growing skull fractures occur in infancy and early childhood. Since the growth of brain is necessary as a driving force for these lesions to occur, almost all reported cases have been before the first 3 years of life. Although a number of uncommon locations, such as basiooccipital and skull base areas, have been reported, they are commonly located on calvaria. The authors report a growing skull fracture on the orbital roof in a 16-year-old female admitted to hospital with complaints of headache and seizures. She had had an orbital trauma 8 years before. CT scan revealed a hypodense lesion in the right frontal lobe and a diastatic fracture line on the right orbital roof. A right craniotomy was performed. Excision of arachnoid loculations and duraplasty were carried out. This is an unusual condition with respect to the location of the lesion, as well as the age of the patient.
