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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 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 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.
