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Öğe Clinical and radiological outcomes of patients on whom posterior C1-C2 stabilization is applied in C2 odontoid fractures(2021) Pasahan, Ramazan; Guldogan, EmekC2 odontoid fractures constituting 18% of total cervical fractures have a high mortality rate. These fractures may be treated with surgical methods such as external immobilization and odontoid screwing, and anterior or posterior transarticular screwing. Our study presents the clinical and radiological outcomes of patients who received C1-C2 posterior stabilization in C2 odontoid fractures. Twenty patients who underwent posterior C1-2 stabilization at İnönü University neurosurgery clinic between 01.01.2015 and 01.06.2020 were included in this study. These patients were categorized based on their age, sex, fusion ratio, failure to position the fracture line, comorbid diseases, additional trauma, type of accident, duration of hospitalization, the shape of the fracture line, complications and calcification ratios around the dens, and they were followed up for six months. There was a fusion in the fracture line of 19 (95.0%) patients. It is possible to fail to position the fracture in those with irregular fracture lines among patients, and there was a statistically significant difference regarding this issue (p=0.001). There were 3 (15.0%) patients with calcification around the dens. There was a significant relationship between calcification around the dens and age, where the calcification ratio increased as the age increased (p=0.004). The fusion rate is high among patients who receive C1-C2 stabilization. In patients where calcification develops around the dens, the possibility of neck pain to continue despite the stabilization removal should be kept in mind. In the treatment of C2 odontoid fractures,posterior C1-2 stabilization is an effective method.Öğe Comparison of posterior cranial fossa morphometric measurements in Chiari type I patients with and without syrinx cavity on magnetic resonance imaging(Int Scientific Information Inc, 2022) Dogan, Gulec Mert; Sigirci, Ahmet; Tetik, Bora; Pasahan, Ramazan; Onal, Cagatay; Arslan, Ahmet K.Purpose: To compare the posterior fossa measurements of Chiari type I malformation (CHM1) patients with and without syrinx and with a control group. Material and methods: The patients with syrinx were divided into 2 groupd according to syrinx width/cord width (S/C) ratios: group 1 - S/C ratio < 50%; group 2 - S/C ratio > 50%. The length of the clivus, the AP length of the foramen magnum, the AP length of the posterior fossa, the perpendicular distance between the McRae line and (a) the splenium of corpus callosum, (b) the pons, and (c) the fastigium of the 160 patients and of the 160 control patients were statistically compared. In addition, the measurements of the patients with and without syrinx, according to the S/C ratio, were statistically compared. Results: Syrinx was present in 59 (36.8 %) of the 160 patients. The S/ C ratio was < 50% in 30 (50.9 %) of them, and S/C ratio > 50% in 29 (49.1%) of them. All the measurements in the patient group, except of the AP length of the foramen magnum, were statistically significantly lower than in the control group (p = 0.001). There was no significant difference in the measurements of the patients with syrinx group 1 and the patients without syrinx, but the AP length of posterior fossa was statistically significantly lower in the patients with syrinx group 2 than the patients without syrinx (p = 0.03). Conclusion: The S/C ratio can be a guide to the underlying aetiology.Öğe Concurrence of polyostotic fibrous dysplasia and spinal aspergillus in non-immunocompromised adult patient(2017) Akatlı, Ayşe Nur; Yıldırım, İsmail Okan; Durak, Mehmet Akif; Aladag, Mehmet Arif; Pasahan, RamazanAspergillus, a rare agent in spinal infections, is often transmitted via inhalation. It can be traced as an infectious agent in immunocompromised patients. While in non-immunocompromised patients, it is highly unlikely to cause spondylodiscitis. Radiological findings remind tuberculosis. The recommended medical treatment is applied with Itraconazole and Amphotericin B. Surgical indication involves the presence of progressive neurological deficit, instability and biopsy requirement. Fibrous dysplasia was first reported in 1938 by Lichtenstein and is a benign developmental disorder of the skeletal system with uncertain etiology. Polyostotic type involved more than one bone, while the monostotic type occurs by involving only one bone structure. Spinal involvement may lead to collapse fractures and deformity development and the most common complaint is pain.In our case, these two disorders occur concurrently, causing bone destruction and severe pain, and no similar cases were found in the literature.Öğe Concurrence of polyostotic fibrous dysplasia and spinal aspergillus in non-immunocompromised adult patient: Case report(Inonu University Faculty of Medicine Department of Neurosurgery, Malatya, Turkey, 2017) Pasahan, Ramazan; Durak, Mehmet Akif; Aladag, Mehmet Arif; Akatli, Ayşe Nur; Yildirim, Ismail OkanÖz: Aspergillus, a rare agent in spinal infections, is often transmitted via inhalation. It can be traced as an infectious agent in immuno- compromised patients. While in non-immunocompromised patients, it is highly unlikely to cause spondylodiscitis. Radiological find- ings remind tuberculosis. The recommended medical treatment is applied with Itraconazole and Amphotericin B. Surgical indication involves the presence of progressive neurological deficit, instability and biopsy requirement. Fibrous dysplasia was first reported in 1938 by Lichtenstein and is a benign developmental disorder of the skeletal system with uncertain etiology. Polyostotic type involved more than one bone, while the monostotic type occurs by involving only one bone structure. Spinal involvement may lead to collapse fractures and deformity development and the most common complaint is pain. In our case, these two disorders occur concurrently, causing bone destruction and severe pain, and no similar cases were found in the literature.Öğe Concurrence of polyostotic fibrous dysplasia and spinal aspergillus in non-immunocompromised adult patient:case report(2017) Pasahan, Ramazan; Durak, Mehmet Akif; Aladag, Mehmet Arif; Akatli, Ayşe Nur; Yildirim, Ismail OkanAspergillus, a rare agent in spinal infections, is often transmitted via inhalation. It can be traced as an infectious agent in immunocompromised patients. While in non-immunocompromised patients, it is highly unlikely to cause spondylodiscitis. Radiological findings remind tuberculosis. The recommended medical treatment is applied with Itraconazole and Amphotericin B. Surgical indication involves the presence of progressive neurological deficit, instability and biopsy requirement. Fibrous dysplasia was first reported in 1938 by Lichtenstein and is a benign developmental disorder of the skeletal system with uncertain etiology. Polyostotic type involved more than one bone, while the monostotic type occurs by involving only one bone structure. Spinal involvement may lead to collapse fractures and deformity development and the most common complaint is pain. In our case, these two disorders occur concurrently, causing bone destruction and severe pain, and no similar cases were found in the literature.Öğe Dry Mouth Caused by Facial Nerve Ischemia due to Subarachnoid Hemorrhage: An Experimental Study(Elsevier Science Inc, 2021) Pasahan, Ramazan; Yardim, Ahmet; Karadag, Mehmet Kursat; Alpaslan, Aslihan; Aydin, Mehmet DumluOBJECTIVE: Parasympathetic network damage results in facial nerve damage, sublingual ganglion degeneration, sublingual gland dysfunction, and dry mouth. In this study, subarachnoid hemorrhage (SAH) was considered to be the cause of dry mouth. METHODS: We assessed 23 hybrid rabbits, including 5 control (group 1, Control). One milliliter of serum saline was injected into the cisterna magna of 5 animals (group 2). SAH was induced by injecting 1 mL of autologous blood into the cisterna magna of 13 animals (group 3). The animals were killed after 3 weeks of induction. The animals' sublingual ganglion and sublingual gland were excised for histopathological examination. The number of degenerated cells in the sublingual ganglion, secretory vesicles, and secretory granules in the sublingual gland that contain salivary components were estimated using Sequential Window Acquisition of All Theoretical Mass Spectra data analysis. The values were compared by the Mann-Whitney U-test. RESULTS: The numbers of secretory vesicles in the sublingual gland were 5.3 +/- 1.1 x 10(3) (group 1), 4.23 +/- 0.45 x 10(3) (group 2), and 1.56 +/- 0.22 x 10(3) (group 3); the numbers of secretory vesicles containing saliva in the sublingual gland were 324 +/- 12.18 (group 1), 263 +/- 36.23 (group 2), and 114 +/- 23.14 (group 3); and the numbers of degenerated cells in the sublingual ganglion were 11 +/- 3/mm(3) (group 1), 98.43 +/- 15.54/mm(3) (group 2), and 346 +/- 12.28/mm(3) (group 3) (P < 0.05). CONCLUSIONS: Clinical findings in infection and diseases such as Sjogren syndrome, aseptic meningitis, and SAH are similar. However, until now, SAH has not been demonstrated experimentally to cause dry mouth. Discovering that SAH might cause dry mouth might prevent unnecessary use of antibiotics and decrease morbidity due to the wrong or late diagnosis.Öğe Multi-parameter-based radiological diagnosis of Chiari Malformation using Machine Learning Technology(Wiley-Hindawi, 2021) Tetik, Bora; Dogan, Gulec Mert; Pasahan, Ramazan; Durak, Mehmet Akif; Guldogan, Emek; Sarac, Kaya; Onal, CagatayBackground The known primary radiological diagnosis of Chiari Malformation-I (CM-I) is based on the degree of tonsillar herniation (TH) below the Foramen Magnum (FM). However, recent data also shows the association of such malformation with smaller posterior cranial fossa (PCF) volume and the anatomical issues regarding the Odontoid. This study presents the achieved result regarding some detected potential radiological findings that may aid CM-I diagnosis using several machine learning (ML) algorithms. Materials and Methods Midsagittal T1-weighted MR images were collected in 241 adult patients diagnosed with CM, eleven morphometric measures of the posterior cerebral fossa were performed. Patients whose imaging was performed in the same centre and on the same device were included in the study. By matching age and gender, radiological exams of 100 clinically/radiologically proven symptomatic CM-I cases and 100 healthy controls were assessed. Eleven morphometric measures of the posterior cerebral fossa were examined using 5 designed ML algorithms. Results The mean age of patients was 29.92 +/- 15.03 years. The primary presenting symptoms were headaches (62%). Syringomyelia and retrocurved-odontoid were detected in 34% and 8% of patients, respectively. All of the morphometric measures were significantly different between the groups, except for the distance from the dens axis to the posterior margin of FM. The Radom Forest model is found to have the best 1.0 (14 of 14) ratio of accuracy in regard to 14 different combinations of morphometric features. Conclusion Our study indicates the potential usefulness of ML-guided PCF measurements, other than TH, that may be used to predict and diagnose CM-I accurately. Combining two or three preferable osseous structure-based measurements may increase the accuracy of radiological diagnosis of CM-I.Öğe Non-traumatic non-aneurysmal subarachnoid haemorrhage: Single institutional experience(202) Pasahan, Ramazan; Tetik, Bora; Guldogan, Emek; Durak, M. Akif; Yildirim, İsmail OkanAim: Despite the advanced diagnostic methods we use today, the rate of negative digital subtraction angiography (DSA) is 15% in patients diagnosed with subarachnoidal hemorrhage (SAH), and these types of hemorrhages are named as non-aneurysmal (NASAH). Various factors such as inadequate interpretation of the beginning angiography, vasospasm, thrombosis, intra-cerebral hematoma pressure may cause DSA to be negative. This study aims to determine the causes of bleeding in patients who were suffered from NASAH. Materials and Methods: The study evaluated 664 patients with SAH from 2010 to 2016. DSA was performed on these patients within the first 3 or 6 hours. Sixty-seven patients with DSA negative were included in the study group. The patients were divided into three groups as perimesencephalic subarachnoidal hemorrhage (PMSAH), non-perimesencephalic subarachnoidal hemorrhage (nPMSAH), CT negative subarachnoidal hemorrhage (CT negative SAH). These three groups were evaluated based on age, gender, Glascow coma scale (GCS), World Federation of Neurosurgical Societies (WFNS) grade, Hunt and Hess Classification and Fisher’s scale, hospitalization time duration, complications and computerized tomography (CT), and cervical and cranial MRI was performed on patients without correlation between DSA results if needed. Results: Of the 664 patients diagnosed with SAH, 67 (10.09%) had NASAH. Statistically significant differences were found between CT Negative SAH and PMSAH and CT Negative SAH and nPMSAH in terms of the variables of GCS during hospital admission and total duration of hospitalization. Statistically significant differences were found between CT Negative SAH and PMSAH and nPMSAH in terms of the variables of GCS during hospital discharge. There were statistically significant differences between the types in terms of WFNS Classification, Hunt and Hess Classification and Fisher’s Scala. Conclusion: We believe that this study will contribute to the literature about the necessity of performing additional radiologic imaging during clinical follow-up since belated diagnosis in patients with NASAH may increase mortality.Öğe Synthesis and investigation of antiproliferative activity of Ru-NHC complexes against C6 and HeLa cancer cells(Tubitak Scientific & Technological Research Council Turkey, 2022) Pasahan, Ramazan; Akkoc, Mitat; Yasar, Seyma; Kul Koprulu, Tugba; Tekin, Saban; Yasar, Sedat; Ozdemir, IsmailThe 2-methylpyridine, 2-diethylaminoethyl, and isopentyl linked a series of symmetric and unsymmetric benzimidazolium salts 2a-e were prepared and used in the synthesis of silver-N-heterocyclic carbene (NHC) complexes (3a-e). The Ru(II)-NHC complexes (4a-h) were synthesized via transmetalation reaction from 3a-e. 4a-h complexes were converted to Ru(II)-NHC. HCl complexes (5a-h) by HCl solution of diethyl ether and characterized by different spectroscopic techniques such as H-1 and C-13 NMR, LC/MS-Q-TOF, FT-IR, elemental analysis, and melting point detection. We examined the effect of the structural difference of complexes on anticancer activity via different arenes and metal centers. Antiproliferative activity of 5a-h and 3a was tested against human cervix adenocarcinoma (HeLa) and rat glioblastoma (C6) cell lines by ELISA assay. The IC50 value of 5b, 5c and 5e complexes exhibited good cytotoxic activity than cisplatin on C6 (14.2 +/- 0.5 mM; 16.2 +/- 0.4 mM; 24.2 +/- 0.7 mM, respectively) and HeLa (11.1 +/- 0.5 mM; 13.7 +/- 0.3 mM; 22.8 +/- 0.8 mM, respectively) cell lines.Öğe Undetectable Brain Metastasis of Hepatocellular Carcinoma by PET-CT After Liver Transplantation: a Case Report(Springer, 2023) Sahin, Emrah; Ince, Volkan; Sahin, Tolga T.; Kutlu, Ramazan; Pasahan, Ramazan; Yilmaz, SezaiPurpose Management of the unexplained AFP elevation after transplantation. F18 FDG PET/CT may not be helpful to detect post-transplant brain metastasis of hepatocellular carcinoma (HCC). Case Report A-61-year old male patient with HBV related HCC have undergone living donor liver transplantation after successfully downstaging. AFP level started to increase on Post-transplant one year and there was no detectable metastases on PET/CT, abdominal thorax tomography. Patient admitted to hospital with confusion and seizure on post-transplant 16th month and diagnosed brain metastasis by brain tomography. Surgical resection was performed but the patientd died on post-transplant 20th month. Conclusion In the unexplained elevation of AFP after transplantation, it is beneficial to keep brain metastases in mind and perform cranial scanning with conventional imaging methods (CT, MRI) rather than FDG PET.Öğe Y-stent assisted coiling of ruptured wide neck intracranial aneurysm in the acute phase(Sage Publications Inc, 2021) Yildirim, Ismail Okan; Kolu, Mehmet; Durak, Mehmet Akif; Tetik, Bora; Pasahan, Ramazan; Gurbuz, Sukru; Sarac, KayaBackground The objective of the present study is to analyze the outcomes of patients with subarachnoid hemorrhage (SAH) in the acute phase after treatment with Y-stent-assisted coiling (YSAC) embolization. Methods This retrospective study assessed of 30 patients with acutely ruptured wide-neck aneurysms following YSAC treatment between April 2013 and October 2019. The demographic data, aneurysm occlusion grade, procedural and periprocedural complications, and clinical outcomes were assessed. Results The procedure was completed in 30 cases (90.1%) and technical failure occurred in 3 cases (9.1%). Immediate control angiography revealed that total occlusion Raymond-Ray Class 1 (RR1) was achieved in 21 (70%), neck filling (RR2) in eight (26.6%) and sac filling (RR1) in one (3.3%) aneurysm. Upon angiographic follow-up, RR1 occlusion was observed in 15 (71.4%) patients, RR2 in three (14.3%) patients and RR3 in three (14.3%) patients. In-stent thrombus developed in five (16.6%) patients; procedural ischemic events were observed in four (13.3%) patients; and two (6.6%) patients were symptomatic. A periprocedural asymptomatic intracranial hemorrhage was detected in two patients. At discharge, 17 (56.6%) patients were in good clinical condition, six (20%) were in a severe disability condition, and seven (23.3%) patients had died. At the final follow-up visit (mean: 18.9 months), 16 (76,2%) of 21 patients were in a good clinical condition and five (23.8%) had severe disabilities. Conclusions Y-stent assisted coiling in might be a feasible and promising option for treatment in acute phase in selected wide-necked ruptured intracranial aneurysms.
