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Öğe Accuracy of fluoroscopically-assisted pedicle screw placement: analysis of 1,218 screws in 198 patients(ELSEVIER SCIENCE INC, 2014) Köktekir, Ender; Ceylan, Davut; Tatarlı, Necati; Karabağlı, Hakan; Recber, Fahri; Akdemir, GökhanBACKGROUND CONTEXT: We retrospectively analyzed a total of 1,218 pedicle screws for accuracy, with postoperative computed tomography (CT), in 198 patients who were operated on between March 2004 and September 2012. PURPOSE: To determine the incidence of screw misplacement in patients who received a transpedicular screw fixation, with intraoperative fluoroscopy in the lateral and lateral with anteroposterior (AP) positions. The results are compared between the two groups. STUDY DESIGN: Retrospective comparative study of accuracy of pedicle screw placement in thoracic and lumbar spine. PATIENT SAMPLE: The sample consists of 198 consecutive patients who underwent transpedicular screw fixation. OUTCOME MEASURES: Accuracy of screw placement was evaluated by postoperative CT scan. Misplacement was defined in cases where more than 25% of the screw size was residing outside the pedicle. METHODS: The indications for hardware placement, radiologic studies, patient demographics, and reoperation rates were recorded. Five hundred twenty-eight screws (Group A, n = 81) were inserted into the vertebral body with the assistance of lateral fluoroscopy only, whereas 690 screws (Group B, n = 117) were inserted with the assistance of lateral fluoroscopy, and the final positions of the screws were checked with AP fluoroscopy. RESULTS: A total of 1,218 screws were analyzed, with 962 screws placed at the lumbosacral region and 256 screws at the thoracic region. According to the postoperative CT scan, 27 screws (2.2%) were identified as breaching the pedicle. Nineteen of them (3.6%) were in Group A, whereas 8 (1.16%) were in Group B. The rate of pedicle breaches was significantly different between Group A and B (p5.0052). In Group A, the lateral violation of the pedicle was seen in 10 screws (1.9%), whereas medial violation was seen in 9 screws (1.7%). In Group B, the lateral violation of the pedicle was seen in six screws (0.87%), whereas medial violation was seen in two screws (0.29%). The medial and lateral penetration of screws were significantly different between Groups A and B (p = .05). A pedicle breach occurred in 21 patients, and 15 of them underwent a revision surgery to correct the misplaced screw. Of these patients, 11 (13.6%) were in Group A, and 4 (3.4%) were in Group B (p = .0335). CONCLUSIONS: In this study, we evaluated and clarified the diagnostic value of intraoperative fluoroscopy in both the lateral and AP imaging that have not yet been evaluated in any comparative study. We concluded that the intraoperative use of fluoroscopy, especially in the AP position, significantly decreases the risk of screw misplacement and the results are comparable with other advanced techniques. (C) 2014 Elsevier Inc. All rights reserved.Öğe Influence of Prior Lumbosacral Surgery on The Incidence of Intravascular Injection During Transforaminal Epidural Injections(JOURNAL NEUROLOGICAL SCIENCES, 2015) Suslu, Husnu; Suslu, Hikmet Turan; Tatarli, Necati; Ceylan, Davut; Guclu, Bulent; Karabagli, HakanObjective: Percutaneous lumbar transforaminal epidural steroid injections are frequently used to treat low back pain. However, many reports have indicated that this procedure has a high risk of morbidity. The aim of this study was to determine the difference in the incidence of vascular penetration during lumbosacral transforaminal epidural injections between patients with previous lumbar spinal surgery and patients who did not undergo surgery. Design: This is a prospective clinical study. Methods: In this study, patients who received lumbar transforaminal epidural injections at an outpatient spine center were included and followed. An interventional spine physician observed fluoroscopically guided lumbosacral transforaminal epidural steroid injections under live fluoroscopy and recorded contrast patterns. A total of 296 fluoroscopically guided lumbosacral transforaminal epidural steroid injections under live fluoroscopy in 108 patients were evaluated. Results: The incidence of vascular contrast patterns was observed under live fluoroscopy. Vascular injections were observed in 28 of the 296 injections, for an overall incidence of 9.5%. The incidence of intravascular injections among patients was 40.0% (20/50) in the previously operated group and 13.8% (8/58) in the non-operated group. This difference was statistically significant (p<0.001). A secondary analysis was performed to determine if the other factors affected the success of the procedure or increased the incidence of vascular injections. Conclusion: Our results indicated that previous surgery affected intravascular dissemination and increased the risk of vascular injection. Cohesional area caused by previous surgery complicated the injection. Additionally, fluoroscopy count and operation time were also affected by previous surgery.Öğe Laboratory Training in Bifrontal and Frontolateral Approaches Using Cadaveric Silicone-Injected Cow Craniums(JOURNAL NEUROLOGICAL SCIENCES, 2015) Tatarli, Necati; Turan Suslu, Hikmet; Ceylan, Davut; Seker, Askin; Karabagli, Hakan; Kotktekir, Ender; Ozdogan, SelcukBackground: A microneurosurgical laboratory training model was designed for trainees in neurosurgery to help them to learn how to handle surgical microscopes and microneurosurgical instruments. A silicone-injected fresh cadaveric cow cranium is a suitable alternative to using a cadaveric human brain for gaining familiarity with the frontal cranial nerves and vascular structures for bifrontal and frontolateral approaches. Methods: A silicone-injected cadaveric cow cranium was prepared by irrigating the major vessels, followed by the injection of silicone colored either red or blue. Results: A three-step approach was designed to simulate microneurosurgical dissection along the frontal lobe and for the dissection of cranial nerves and vascular structures. This laboratory training model is useful for trainees to gain experience in the use of an operating microscope and become more familiar with the anterior neural and vascular structures in bifrontal and frontolateral approaches. Conclusion: The aim of this study was to develop an innovative model to create a life-like microneurosurgical training system. This model simulates bifrontal and frontolateral approaches performed on the human brain.Öğe Symptomatic Pneumorrhachis(THIEME MEDICAL PUBL INC, 2014) Köktekir, Ender; Tatarlı, Necati; Ceylan, Davut; Köktekir, Bengü Ekinci; Akdemir, GökhanPneumorrhachis (PR) is the presence of air within the spinal canal, whether localized in the epidural or in the subarachnoid space. Evidence of intraspinal air, especially in the subarachnoid space, had been thought to be merely a radiological artifact of serious underlying pathology until it was proven that PRs can be related to neurologic symptoms ranging from radicular pain to serious neurologic deficits. The etiologies, pathomechanisms, and natural courses show differences from case to case, with the result that no consistent treatment strategies exist in the literature. Although the conservative treatment modalities seem to be more appropriate in nonsymptomatic cases, treatment strategies in symptomatic cases remain the subject of discussion. In this study, we present two symptomatic cases of PR arising from different causes and review the literature, focusing especially on the symptomatic cases and strategies for treating them.Öğe An Unusual Mechanism of Delayed Intracerebral Hemorrhage After Ventriculoperitoneal Shunting: Case Report(Ege University Press, 2012) Koktekir, Ender; Tatarlı, Necati; Ceylan, Davut; Karabağlı, Hakan; Akdemir, GökhanWe present a case of delayed intracerebral hemorrhage that developed seven years after initial ventriculoperitoneal shunt surgery. A seven-year-old boy was admitted to emergency when he experienced sudden headache and vomiting. Computed tomography (CT) scanning showed an intracerebral hemorrhage around the ventricular catheter that cannot be explained by known predisposing factors such as head trauma, coexisting bleeding disorder, occult vascular malformation, and intratumoral hemorrhage. The presumed mechanism in this case is that the ventricular catheter caused contusion of cerebral tissue because the shunt tube at the neck had stretched during the growing up of the child.Öğe An Unusual Mechanism of Delayed Intracerebral Hemorrhage After Ventriculoperitoneal Shunting: Case Report(2012) Koktekir, Ender; Tatarli, Necati; Ceylan, Davut; Karabaglı, Hakan; Akdemir, GökhanBu olgu sunumunda ventriküloperitoneal şant cerrahisinden 7 yıl sonra geç gelişen bir intraserebral hemoraji olgusunu sunuyoruz. 7 yaşında erkek hasta acil servise ani başlayan baş ağrısı ve kusma şikayetleri ile başvurdu. Bilgisayarlı beyin tomografi incelemesi,ventriküler katater etrafında intraserebral hemoraji varlığını gösteriyordu. Hastanın öyküsü,labaratuvar bulguları ve radyolojik incelemelerinde intraserebral hemorajiye neden olabilecek kafa travması, kanama diyatezi, vasküler malformasyon ve intratümoral hemoraji saptanmadı. Bu vakada intraserebral hemorajiye yol açan tahmini mekanizma, çocuğun büyüme döneminde boyun bölgesinde gerilmiş olan şant tüpü nedeni ile ventriküler kataterin gerilmesi ile oluşan serebral dokunun kontüzyonuydu.Öğe An Unusual Mechanism of Delayed Intracerebral Hemorrhage After Ventriculoperitoneal Shunting: Case Report(JOURNAL NEUROLOGICAL SCIENCES, 2012) Köktekir, Ender; Tatarlı, Necati; Ceylan, Davut; Karabağlı, Hakan; Akdemir, GökhanWe present a case of delayed intracerebral hemorrhage that developed seven years after initial ventriculoperitoneal shunt surgery. A seven-year-old boy was admitted to emergency when he experienced sudden headache and vomiting. Computed tomography (CT) scanning showed an intracerebral hemorrhage around the ventricular catheter that cannot be explained by known predisposing factors such as head trauma, coexisting bleeding disorder, occult vascular malformation, and intratumoral hemorrhage. The presumed mechanism in this case is that the ventricular catheter caused contusion of cerebral tissue because the shunt tube at the neck had stretched during the growing up of the child.Öğe Vascular Silicone Injection of Fresh Cadaveric Cow Cranium: Alternative Training Model For The Human Brain(JOURNAL NEUROLOGICAL SCIENCES, 2015) Tatarli, Necati; Suslu, Hikmet Turan; Ceylan, Davut; Seker, Askin; Karabagli, Hakan; Koktekir, Ender; Ozdogan, SelcukBackground: Anatomical and physiological variations of the human brain's vascular system can be observed via silicone injection of the arterial and venous systems. As a novel method, the injection of a fresh cadaveric cow cranium with silicone is an alternative to using the human brain for microanatomical studies. Objective: To report on an improved method for the colored silicone injection of a fresh cadaveric cow cranium using a silicone injection technique. Methods: Five fresh cow crania were injected as an alternative to human brains for microanatomical dissection, in which the preparation consisted of the irrigation of the major vessels and the injection of colored silicone. Cannulation of the internal carotid arteries and the internal jugular veins with catheters was performed, and the vasculature was irrigated with water (major arteries and veins). The fixation of the specimen with either formaldehyde or alcohol, and the colored injection of the arteries and veins with red and blue silicone, respectively, was then performed. Results: The silicone injections resulted in the deeper penetration of the colored solutions into the small cerebral vessels and mesenchymal structures of the fresh cadaveric cow crania. Of the five injected specimens, four exhibited successful injections, while one had suboptimal results. Conclusion: Silicone injection of the cadaveric cow brain, based on the anatomical and physiological assessment of the vasculature of the specimen for microanatomical studies, is suggested as an alternative to using human brain specimens.Öğe Vascular Silicone Injection of Fresh Cadaveric Cow Cranium: Alternative Training Model For The Human Brain(2015) Tatarlı, Necati; Süslü, Hikmet Turan; Ceylan, Davut; Şeker, Aşkın; Karabağlı, Hakan; Köktekir, Ender; Özdoğan, SelçukArka plan: İnsan beyin damar sisteminin anatomik ve fizyolojik farklılıkları, arteriyel ve venöz sistemlerin silikon enjeksiyonu ile görülebilir. Yeni bir yöntem olarak, taze inek kranium kadavrasının silikon injeksiyonu, mikroanatomik çalışmalar için insan beyninin silikon enjeksiyonuna bir alternatiftir. Amaç: Amacımız, silikon enjeksiyon tekniği kullanarak taze inek kranium kadavrasının renkli silikon enjeksiyonu için geliştirilmiş bir metot bildirmektir. Yöntem: İnsan beynine alternatif olarak mikroanatomik diseksiyonlarda kullanmak üzere beş adet taze inek kraniumu, injekte edildi. Hazırlık, majör damarların yıkanması ve renkli silikon injeksiyonunu içerir. Sırasıyla internal karotis arter ve internal juguler venlerin kateterle kanülasyonu, ana arter ve venlerin su ile yıkanması, kraniumun alkol veya formaldehit ile fikse edilmesi, kırmızı ve mavi silikon ile arter ve venlerin renkli injeksiyonu uygulandı. Bulgular: Silikon injeksiyonları, taze inek kranium kadavrasında, küçük beyin damarlarının ve mezenkimal yapıların içine renkli solüsyonların derin penetrasyonunu sağladı. İnjeksiyon yapılmış beş kraniumun dördünde başarılı olundu. Birinde ise suboptimal sonuçlara varıldı. Sonuç: Mikroanatomik çalışmalar için kraniumun damarlarının anatomik ve fizyolojik değerlendirilmesi temelinde, silikon injekte edilmiş inek kranium kadavrası, insan beyin kadavrasına bir alternatif olarak önerilmiştir.
