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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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    The Effects of Stereotactic Cerebroventricular Administration of Albumin, Mannitol, Hypertonic Sodium Chloride, Glycerin and Dextran in Rats with Experimental Brain Edema
    (Turkish Neurosurgical Soc, 2017) Ates, Tuncay; Gezercan, Yurdal; Menekse, Guner; Turkoz, Yusuf; Parlakpinar, Hakan; Okten, Ali Ihsan; Akyuva, Yener
    AIM: To evaluate the effects of cerebroventricular administration of hyperoncotic/hyperosmotic agents on edematous brain tissue in rats with experimental head trauma. MATERIAL AND METHODS: The study included 54 female Sprague-Dawley rats with weights ranging between 200 and 250 g. Six experimental groups were examined with each group containing 9 rats. All rats were exposed to head trauma, and treatment groups were administered 2 mu l of one of the drugs (albumin, mannitol, hypertonic sodium chloride (NaCl), glycerin and dextran) 6, 12 and 24 hours after the trauma via the cerebroventricular route and using a stereotactic device. Rats were sacrificed 48 hours after the trauma, and brain tissues were extracted without damage. Biochemical analyses including reduced glutathione (GSH), nitric oxide (NO), malondialdehyde (MDA), tumor necrosis factor alpha (TNF-alpha), and interleukin 1 beta (IL-1 beta) were performed on the injured left hemisphere. RESULTS: Compared with the control group, the albumin, mannitol, 3% NaCl and glycerin treatment groups revealed dramatic increases in GSH levels (p < 0.001). Levels of MDA, which is the end-product of brain edema and lipid peroxidation, failed to show a statistically significant decrease, but there was a decreasing trend observed in the inter-group comparisons. NO levels were also decreased in the 3% NaCl treatment group. An analysis of TNF-alpha and IL-1 beta, two proinflammatory cytokines associated with the trauma, revealed that IL-1 beta decreased significantly in all treatment groups (p=0.001), whereas no significant difference was detected in TNF-alpha levels. CONCLUSION: Cerebroventricular administration of hyperoncotic/hyperosmotic agents provides substantial effects on the treatment of brain edema.
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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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    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.
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    Surgical treatment of intracranial meningiomas in patients over 65 years old: A retrospective study of 70 cases
    (2017) Menekse, Guner; Gezercan, Yurdal; Okten, Ali Ihsan
    Aim: Intracranial meningiomas are the most common types of brain tumor in patients over 65 years of age. Surgical resection in this group of patients may be at risk of severe complications, due to limited physiological capacities and the presence of comorbidities. This retrospective study aimed to summarise outcome data of patients older than 65 years who underwent surgery for intracranial meningioma at our clinic between Jan 2007 and Dec 2012. Materials and Methods: Medical records of 70 cases diagnosed with intracranial meningioma were retrospectively reviewed. Demographic and clinical data (age, sex, symptoms), tumor localization, histopathologic properties, American Society of Anesthesiology (ASA) class, complications of the early postoperative period were analyzed. Results: Male/female ratio was 0.37 and mean age was 71.3. The most common experienced symptoms were headache (78.5%), motor deficit (18.5%) and seizure (17.1%). Tumors were mostly settled to convexities (34.3%) and parasagittal regions (17.1%). Histopathological diagnoses were classified as follows; Meningothelial (40.0%), transitional (18.6%), fibroblastic (114%) and psammomateous (11.4%). Postoperative complications were manifested in 10 of 70 patients (14.2%) Complication rate was prominently higher in patients with class III and IV of ASA class. Conclusions: Surgery for intracranial meningiomas in selected elderly patients is beneficial. Old age alone should not be used as a selection criterion for treatment.