Abdullah Hilmi Marangoz

The evaluation of three-dimensional anatomy of the superficial temporal artery using the volume rendering technique.

AIM The superficial temporal artery (STA) is the one of the terminal branches of the external carotid artery. Three-dimensional anatomical structure of the STA can be evaluated by using three dimensional volume rendering technique (3D-VRT) from acquired two-dimensional contrast-enhanced computerized tomographic images. MATERIAL AND METHODS The raw data of the Three-dimensional Computerized Tomography Angiography (3D-CTA) was transferred to computer and recorded in a software program. This software program created the three-dimensional images of STA using these transferred raw data with the volume rendering technique. These images were evaluated in terms of the location of the STA bifurcation, the distance from the some anatomical landmarks, the inner diameter of the artery, and the type of the variations. RESULTS The total number of patients consists of 53 (27 female and 26 male) patients. The mean age of the patients was estimated as 57.9 ± 9.7 years. It was found that the location of the STA bifurcation was over the posterior third of the zygomatic arch in 58% of the cases. In 40% of the cases the location of the bifurcation was above the zygomatic arch. The location of the bifurcation was below the zygomatic arch in the remaining part of the cases (2%). CONCLUSION The STA images created using the volume rendering technique were evaluated in terms of the bifurcation point of the artery, the length of the bifurcation from some anatomical structures, the inner diameter of the artery and arterial variations. The results of this study showed that this technique might be helpful for the three-dimensional microsurgical anatomy of the STA in daily neurosurgical practice.

Three-Dimensional Microsurgical Anatomy of the Choroid Plexus Using the Volume Rendering Technique.

AIM The choroid plexus (CP) is a specific anatomical structure producing cerebrospinal fluid into the ventricular space. The three-dimensional anatomical structure of the choroid plexus located within the lateral ventricle may be evaluated by using the three dimensional volume rendering technique (3D-VRT) from acquired two-dimensional contrast enhanced computerized tomographic images. MATERIAL AND METHODS The raw data of Three-dimensional Computerized Tomography Angiography (3D-CTA) were transferred into the computer and recorded in a software program. These images were evaluated in terms of anatomical shape, borders, extensions length and dimensions. RESULTS The patient group consisted of 57 (27 female and 30 male) patients. The mean age of the patients was 55±9 years. In male individuals, the distance of the superior tip from Fraziers point was 7.96±0.71 centimeters at the right side. In males, the distance of the inferior tip of the CP was estimated as 1.93±0.26 centimeters posterior-lateral from the anterior clinoid process, 1.64±0.23 centimeters posterior-lateral from the bifurcation of internal carotid artery, and 2.86±0.23 centimeters posterior-medial from the bifurcation of middle cerebral artery on the right side. CONCLSION The results of this study showed us that this technique could be used in the three-dimensional evaluation of some anatomical structures such as the choroid plexus.

Three Dimensional Microanatomy of the Ophthalmic Artery: Spontaneous Intracranial-Extracranial Anastomosis Site within the Orbital Cavity.

AIM The aim was to evaluate three-dimensional structure of the ophthalmic artery (OphA). MATERIAL AND METHODS The raw data of the Three-dimensional Computerized Tomography Angiography (3D-CTA) were transferred to computer and recorded in a software program. RESULTS The study group consisted of 45 (24 female and 21 male) patients. The mean age of the patients was 56 ± 9.5 years. It was found that the entry point of the OphA to the orbital cavity was inferior to the optic foramen in 29 (64.44%) of the cases. The length of the postcanalicular-prelacrimal was 0.54 ± 0.13 centimeters at the right side and 0.51 ± 0.13 centimeters at the left side. The distance of the postlacrimal-presupraorbital segment was 0.43 ± 0.11 centimeters at the right and left sides. The location of the anastomosing site was 0.97 ± 0.42 centimeters from the supraorbital notch. CONCLUSION The results of this study showed us that this technique could be used in the evaluation of the three-dimensional microsurgical anatomy of the OphA and its critical extracranial-intracranial anastomosing site.

The Neuroendoscopic Assisted Microsurgical Evacuation of Chronic Subdural Hematomas

Aim: The primary objective of this study was to emphasize the importance of using neuro-endoscope in the microsurgical evacuating of chronic subdural hematomas with the placement of bur hole(s). Material and Method: The illustrative case was a 67 years old male with one week history of headache. Obtained computed tomography of the head showed the presence of the left frontoparietal chronic subdural hematoma. Results: The patient was operated under general anesthesia. Two burr-holes were placed on the frontal and parietal regions. The chronic subdural hematoma was micro-surgically evacuated after opening of the Dura mater and the parietal membrane of hematoma. After this stage, neuro-endoscopic assistance was used in the obtaining of panoramic view inside the cavity. The presence of hematoma and active bleeding was observed in the cavity. In the other hand the correct placement of drainage catheter was checked by using endoscopic guidance. Discussion: It was concluded that neuro-endoscopic procedure could make microsurgical evacuation of chronic subdural hematoma safer with intraoperative real-time panoramic visualization of the space and may also allow for the identification of active bleeding, septal cavitations, parietal-visceral bridging structures, sediment collections, venous indentations, and catheter position within the cavity.

Using of three dimensional volume rendering angiography in the determination of vessel-free areas of the scalp in the patients underwent intracranial aneurysm surgery during the placement of three-pins metallic head fixation device

Three-pins head holder device has been safely used for many years in many neurosurgical procedures for providing 3-point rigid cranial fixation. Equal impingement of pins ensures firm skull positioning and fixation after carefully positioning of skull pins around the vessel free areas. The raw data of the three-dimensional computerized tomography angiography (3D-CTA) obtained from the patients with subarachnoid hemorrhage were transferred to computer and recorded in a software program. This software program created three-dimensional images of skull using previously transferred raw data with volume rendering technique. Safe areas for pins placement, in terms of vessel-free areas, were determined using three-dimensional volume rendering angiography of the skull. The study group consists of 53 (27 female and 26 male) patients. The mean age of the patients was estimated as 57.9±9.7 years. Branches, distribution and critical anastomosis of the superficial temporal artery were also determined. In the other way, the course of the posterior auricular and occipital artery ascending along the external surface of the mastoid bone was also detected in all cases. In the patients underwent surgery for intracranial aneurysm, using of three-dimensional volume rendering angiography may be used in the determination of vessel-free areas of the external surface of the scalp during the placement of three-metallic pins of head holder device.

The Contribution of Three-Dimensional Computerized Tomographic Angiography in the Head Positioning of the Patients with Middle Cerebral Artery Aneurysms.

Surgical intervention is a gold standard technique for ruptured and unruptured middle cerebral artery bifurcation aneurysm. Before surgical intervention it is necessary to know the three-dimensional shape, surgical position, projection and position of the aneurysm and the course of the parent artery. In a demonstrative case with middle cerebral artery aneurysm, using the OsiriX MD image processing software for DICOM images, it was demonstrated the position of the aneurysm neck, the projection of the aneurysm and the course of the M1 segment in relation with dynamic rotation and extension of the head. These dynamic videographic neuroradiological images may enhance the surgical anatomic perspective of the surgeon before the surgical intervention.

Fusiform Enlargement of the Superficial Temporal Artery in the Cases with Intracranial Aneurysm.

AIM The superficial temporal artery is one of the main terminal branches of the external carotid artery. This artery ascends through the lateralposterior margin of the zygomatic arch to reach the temporal region of the scalp. The superficial temporal artery divides its frontal and parietal branches around the zygomatic arch. MATERIAL AND METHODS The raw data of the Three-dimensional Computerized Tomography Angiography (3D-CTA) were transferred to computer and recorded in a software program. This software program created the three-dimensional images of the superficial temporal artery using these transferred raw data with volume rendering technique. RESULTS Fifteen cases (5 female and 10 male, mean age 54.26 ± 12.35 years) with intracranial aneurysm were evaluated in terms of the type, location and dimensions of the fusiform enlargements. Fusiform enlargement was bilateral in eleven of the cases. Remaining four cases have unilateral fusiform enlargement of the superficial temporal artery. CONCLUSION Fusiform enlargement of the superficial temporal artery may be seen in the cases with intracranial aneurysms. 3D-CTA should be carefully evaluated in the demonstration of extracranial-intracranial vascular pathologies.

Application of three-dimentional computerized tomographic angiography in the planning of pterional scalp incision to preserve the superficial temporal artery.

A standard pterional scalp incision is commonly used in the surgical treatment of lesions located at the cranial base. There is a close relationship between the superficial temporal artery and a pterional scalp incision. Standard pterional scalp incision is widely used in the aneurysm surgery of the basal cerebral arteries. Three-dimensional computerized tomographic angiography (3D CT Angiography) using the three-dimensional (3D) volume rendering technique is commonly used in the neuroradiological diagnosis of intracranial aneurysms. 3D CT Angiography produced for the mentioned purpose may concomitantly be used without any additional investigation for the imagination of superficial temporal artery. Virtual skin incision may be done in the computer software under the illumination of data obtained from the 3D CT Angiography. In this study, we investigated the applicability of this technique using 3D CT Angiography. In conclusion, using this technique in cases undergoing surgery with standard pterional scalp incision may preserve the superficial temporal artery leading to the prevention of the skin problems originating from insufficient blood supply, and allowing the use of the preserved superficial temporal artery for cranial anastomosis surgery in the future.

Surgical Treatment of Internal Carotid Bifurcation and Pericallosal Artery Aneurysms with Unilatera

DOI: 10.4328/JCAM.1351 Received: 25.10.2012 Accepted: 19.11.2012 Printed: 01.07.2014 J Clin Anal Med 2014;5(4): 283-6 Corresponding Author: Cengiz Çokluk, Ondokuzmayıs Üniversitesi, Tıp Fakültesi, Beyin ve Sinir Cerrahisi Anabilim Dalı Samsun, Türkiye. T.: +90 3623121919/3086 F.: +90 3624576041 E-Mail: cengizcokluk@yahoo.com Özet Amaç: Anevrizmalar subaraknoid kanamanın başta gelen nedenleri arasındadır. En sık görülen anevrizma şekli tekli anevrizmadır. Ancak nadir olmamakla birlikte çoklu anevrizmalar da görülebilir. Gereç ve Yöntem: Daha önceden rüptüre olmuş sol internal karotid arter bifurkasyon anevrizması nedeniyle ameliyat edilmiş 55 yaşında kadın olgu bir ay kadar sonra insidental sağ internal karotid bifurkasyon ve perikallosal arter anevrizması nedeniyle hastaneye, cerrahi tedavi için yatırıldı. Bulgular: Cerrahi tedavi sırasında, karşı taraf pupilla hizası saçlı deri sınırından başlayarak ipsilateral pterional bölgeye gelen cilt insizyonu planlandı. Bu insizyon sağ para median kraniyotomi ve pteriyonel kraniotomi yapılmasına imkan sağlamaktaydı. Öncelikle pteriyonel kraniyotomi yapıldı. Silviyan diseksiyonu takiben internal karotid arter bifurkasyon bölgesinde lokalize anevrizmaya ulaşıldı. Anevrizma diseke edilerek klipe edildi. Daha sonra sağ frontal paramedian kraniyotomi yapıldı ve interhemisferik fissürden ilerlenerek perikallosal arterde yerleşik anevrizma kliplendi. Tartışma: Bu tip çoklu anevrizma yerleşimlerinde klasik pteriyonel cilt insizyonu tek taraflı frontopteriyonel insizyona modifiye edilerek tek seferde iki kraniyotomi ile heriki anevrizma da tedavi edilebilir.

Penisilinle oluşturulan epilepside kolinerjik ve nitrerjik maddelerin diken amplitüdüne etkisi The effects of cholinergic and nitrergic substances on spike amplitude in penicillin induced epilepsy

Literaturde asetilkolinin (ACh) ve nitrik oksitin (NO) epilepsideki yeriyle ilgili calismalar vardir. Bununla birlikte herhangi bir epilepsi modelinde muskarinik kolinerjik sistem ile nitrerjik sistem arasindaki etkilesim bilinmemektedir. Sunulan calismanin amaci, penisilin modeli deneysel epilepside, nitrerjik sistem ile muskarinik kolinerjik sistemin etkilesimini arastirmaktir. Deneylerde agirliklari ortalama 220±35 gram olan 70 tane Wistar cinsi eriskin erkek sican kullanildi. Bu hayvanlar kontrol (200 IU/1μl penisilin), sodyum nitropurisid (SNP) (50 μg/5 μl), Nω-nitro L-arjinin metil ester (L-NAME) (100 μg/5 μl), ACh (250 μg/5 μl, i.c.), atropin (100 ng i.c.), atropin+SNP (100 ng atropin ve 10 dk sonra 50 μg SNP i.c.), atropin+L-NAME (100 ng atropin sulfat ve 100 μg/5 μl L-NAME i.c.), L-NAME+ACh (100 μg/5 μl L-NAME ve 10 dk sonra 250 μg/5 μl ACh i.c.), ACh+SNP (250 μg/5μl ACh ve 50 μg SNP i.c.) ve Atropin+ACh gruplarina ayrildi. Calismamizin sonuclarina gore intrakortikal penisilinden (200 IU/1 mikro litre) 2-5 dakika sonra ECoG’de epileptiform aktivite basladi. Asetilkolin ile SNP birlikte verildiginde, 10. dakikadan itibaren deneylerin sonuna kadar penisilinin olusturdugu epileptiform aktivite ve diken yukseklikleri, istatistik acidan cok onemli olcude baskilandi. Muskarinik kolinerjik ve nitrerjik sistemlerle ilgili diger uygulamalar ve diger maddeler diken yuksekliklerini istatistiksel acidan onemli sayilabilecek olcude etkilememistir. Sonuc olarak deney sartlarinda, asetilkolin tek basina uygulandiginda penisilinin olusturdugu epileptiform aktiviteyi siddetlendirmekte; fakat bir NO verici olan SNP ile birlikte verilince antikonvulzan etki artmakta ve diken yukseklikleri azalmaktadir. The effects of cholinergic and nitrergic substances on spike amplitude in penicillin induced epilepsy The role of acetylcholine (ACh) and nitric oxide (NO) in epilepsy is already known. There is no study on the interactions between cholinergic and nitrergic systems in an epilepsy model. The aim of this study was to investigate the interaction between muscarinic cholinergic system and nitrergic system in the experimental model of penicillin epilepsy. Seventy adult male Wistar rats weighing 220±35 g were used in the experiments. The experimental groups consist of control (200 UI/1 μl penicillin), SNP (50 μg/5 μl), N ω-nitro-L-arginine methyl ester (L-NAME)(100 μg/5 μl), ACh (250 μg/5 μl), atropin (100 ng,), atropin+SNP (100 ng atropine and 10 min later 50 μg SNP), atropin +L-NAME (100 ng atropine sulphate and 100 μg/5 μl L-NAME,), L-NAME+ACh (100 μg/5 μl L-NAME and 10 min later 250 μg/5 μl ACh ), ACh+SNP (250 μg/5 μl ACh and 50 μg SNP) and Atropin+ACh groups. According to the this study, epileptiform activity started within 2-5 min following the intracortical injection of penicillin (200 UI/1 μl). When ACh and SNP were administered together, penicillin induced epileptiform activity and spike amplitudes were significantly suppressed from the 10th min onwards. Amplitudes of the spikes induced by penicillin were significantly reduced in ACh+SNP group while the other compounds related to muscarinic cholinergic and nitrergic systems did not affect it. It can be concluded that acetylcholine increases the epileptiform activity induced by penicillin when administered alone while the anticonvulsant effect is increased when it is administered together with NO donor SNP. J. Exp. Clin. Med., 2012; 29:304-310