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    Diffusion tensor imaging findings of patients with parkinson’s disease refractory to medical treatment
    (2021) Guduk, Mustafa; Cevik Cenkeri, Halime; Yilmaz, Atilla; Uyanik, Sadik Ahmet; Atli, Eray; Oguslu, Umut; Yilmaz, Birnur; Gumus, Burcak
    Aim: Diffusion Tensor Imaging (DTI) findings can be useful to detect and measure neurodegeneration that is seen in Parkinson’s disease (PD). Microstructural changes in regions of the brain related with motor function are evaluated by using DTI measurements of fractional anisotropy (FA) to find out the possible role of the technique in diagnosis in patients with PD. Materials and Methods: The study includes 18 PD patients who were candidates for deep brain stimulation surgery, and 19 control group patients. DTI was performed in all cases. DTI characteristics of FA were measured in primary motor cortex (M1), supplementary motor area (SMA), inferior parietal lobule, putamen (P), globus pallidus externus (GPe) and internus (GPi), ventrolateral nucleus of thalamus (Th), substantia nigra (SN), cuneus, precuneus and cerebellar dentate nucleus (D) bilaterally. Additionally, we processed “raw” FA images and colored them according to fiber orientation to visualize STN and GPi nuclei. Results: Mean age of the control group was 59.2±13.2 (range: 31-79) years, while it was 56.7±16 (range: 42-77) years for the patient group. Mean duration of PD was 12.4±7.1 (range: 5-30) years. Study group FA values were significantly lower than the control group in all areas bilaterally (p<0.05). Additionally, FA-M1, FA-GPi and FA-GPe values were significantly lower on left side compared to right side (p<0.05). Conclusion: Decrease in FA values in all regions in the study group is thought to result from loss of nerve cells. Additionally, raw FA images that are processed, and colored in relation to fiber orientation can be useful for a better identification of STN and GPi nuclei. This type of imaging will provide a more precise anatomy necessary for surgical targeting.
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    Intracranial arterial variations and their relation with cerebral aneurysms: Analysis of 640 patients
    (2020) Uyanik, Ahmet; Uzuncakmak Uyanik, Handan; Oguslu, Umut; Dede, Dogan
    Aim: To evaluate prevalence of cerebral arterial variations in Turkish population and association of the variations with cerebral aneurysmsMaterials and Methods: Digital subtraction angiography of 640 consecutive patients between January 2011-December 2013 were evaluated retrospectively. Patients with aneurysms were compared with patients without aneurysm to determine the effect of variations. Comparisons were made using Chi square or Fisher exact test for categorical variables and Student's t test or Mann Whitney U test for continuous variables.Results: The most common variation in the anterior circulation was hypoplasia of anterior cerebral artery A1 segment and the most common variation in the posterior circulation was fetal origin of the posterior cerebral artery. Hypoplasia and aplasia of the anterior cerebral artery A1 segment was significantly more frequent in patients with anterior communicating artery aneurysms than the control group (p:0.001). Prevalence of azygos anterior cerebral artery variation was higher in distal anterior cerebral artery aneurysms than the control group (p 0.001). There was no association between bihemispheric anterior cerebral artery and anterior communicating artery aneurysms (p = 0.453). Similarly, no significant association of fetal origin of posterior cerebral artery with posterior communicating artery aneurysms was found (p = 0.133). Conclusion: Prevalence of cerebral arterial variations in this study were compatible with literature. Some variations may play a role in development of aneurysms by alterations in hemodynamics and increasing shear wall stress. Further larger studies are needed to clarify the relation between variations in cerebrovascular structure and aneurysm formation.