Ahmet Celal Iplikcioglu

The Results of ??-tricalcium Phosphate Coated Hydroxyapatite (??-TCP/HA) Grafts for Interbody Fusion After Anterior Cervical Discectomy

Study Design The efficacy of tricalcium phosphate and hydroxyapatite (β-TCP/HA) grafts was studied after anterior cervical discectomy (ACD). Objective This study presents our observations about the efficacy of β-TCP/HA grafts after ACD. Summary of Background Data Especially in the last 2 decades, fusion materials such as autograft and allograft, as well as different kind of cages were used to maintain fusion after ACD. Methods β-TCP/HA grafts after ACD were used in 17 patients. The cervical and radicular pain was evaluated via visual analog scale (VAS) score preoperatively, at postoperative third week, and after 20 months (range: 18 to 24 mo) after the operation. The radiologic evaluations were done preoperatively, at postoperative first day and at the latest follow-up. The VAS, intervertebral space ratio, height of intervertebral disc space and neural foramen, and cervical and segmental lordosis angles were recorded preoperatively and during the postoperative follow-up period. The presence of fusion was controlled in computed tomography scans taken at the latest follow-up. Results Both clinical and radiologic evaluations yielded satisfactory results. VAS scores decreased significantly in all patients. The intervertebral space and neural foramen and intervertebral disc heights increased at postoperative day 1 but were found to be decreased at the latest follow-up (P<0.05). On the contrary the cervical and segmental lordosis angles decreased at postoperative day 1 but were found to be increased at the latest follow-up (P<0.05). There was a solid fusion in 16 out of 17 patients (94.11%). Conclusions Although there was a loss of the initially obtained neural foraminal and disc height, the application of β-TCP/HA graft after ACD resulted in a high rate of fusion and patient satisfaction. Additionally, the cervical and segmental lordosis was preserved. We concluded that it is a good alternative to current methods to maintain cervical alignment and fusion after ACD.

Comparison of deferoxamine and methylprednisolone: protective effect of pharmacological agents on lipid peroxidation in spinal cord injury in rats.

Study Design. Experimental study. Objective. To investigate the protective effect of deferoxamine (DFO) administration in comparison with methylprednisolone (MP) on lipid peroxidation and antioxidants after spinal cord injury (SCI) in rats. Summary of Background Data. DFO is used for treating an iron-chelating agent, which is also used in the treatment of iron poisoning and thalassaemia. The neuroprotective effect of DFO was evaulated as a therapeutic agent for SCI. Methods. Forty Wistar rats were randomly divided into 5 groups as sham laminectomy (n = 8), laminectomy with SCI (n = 8), laminectomy with SCI and 0.9% saline intraperitoneal (i.p.) (n = 8), laminectomy with SCI and 30 mg/kg MP i.p. (n = 8), and laminectomy with SCI and 30 mg/kg DFO i.p. (n = 8). Neurological deficits were examined 24 hours after trauma, and all rats were killed. Spinal cord segments were harvested for both biochemical and histopathological evaluation. Results. At 24 hours post-SCI, whereas malondialdehyde levels were increased, superoxide dismutase, catalase, and glutathione peroxidase levels were decreased in groups I, II, and III. MP and DFO treatment decreased MDA levels and increased superoxide dismutase CAT, and glutathione peroxidase levels in control and study groups. There was no statistically significant difference between treatment with MP and DFO (P> 0.05). All rats were paraplegic after SCI, except in the sham group. Histopathological improvement was observed in control and study groups. Conclusion. This study indicates that beneficial effects may be provided and further studies need to investigate the dose-dependent beneficial and side effects of DFO in SCI. Level of Evidence: N/A

A predictive tool by fuzzy logic for outcome of patients with intracranial aneurysm

We aimed to investigate if the outcome of the patients with intracranial aneurysm could be predicted by fuzzy logic approach. Two hundred and forty two patients with the diagnosis of intracranial aneurysm were assessed retrospectively between January 2001 and December 2005. We recorded World Federation of Neurological Surgeons Scale (WFNSS), Fisher Scale and age at admission and Glasgow Outcome Score (GOS) at discharge from hospitalization for all the patients. We developed fuzzy sets by dividing WFNSS into four groups as good, fair, bad and very bad; age into three groups as young, middle and old; Fisher scale into three groups as few, moderate and large; outcome score into four groups as bad, fair, good and very good. We calculated the outcome of the patient with these sets by fuzzy model. Predicted outcome by fuzzy logic approach correlated with observed outcome scores of the patients (p>0, 05), including 95% confidence interval. We showed that outcome of the patients with aneurysm can be predicted by fuzzy logic approach, accurately.

Spinal Extradural Arachnoid Cysts: A Series of 10 Cases.

BACKGROUND AND OBJECTIVE Spinal arachnoid cysts are rare lesions, accounting for only 1% of all primary spinal mass lesions. They can occur in extradural, intradural, or intramedullary locations. The extradural cysts are thought to arise from defects in the dura mater through which the arachnoid herniates. This report presents 10 cases of spinal extradural arachnoid cysts and discusses our diagnostic and therapeutic approach to this rare clinical entity. PATIENTS The archive records of 10 patients with extradural arachnoid cysts who were treated between 2002 and 2009 were evaluated retrospectively. The study included four male and six female patients. In nine cases, the lesion was symptomatic; in only one case was the cyst diagnosed incidentally. Surgical treatment was performed in the nine symptomatic cases. RESULTS In nine of these cases, the extradural cysts were solitary; in one case, multiple extradural cysts were observed. In most of the cases, the lesion was located in the thoracic region. Total excision of the cyst was achieved for all of the cases treated surgically except the case with multiple extradural arachnoid cysts. On follow-up examination, neurologic improvement was observed in all of the surgically treated patients. CONCLUSION Spinal extradural arachnoid cysts are rare pathologies, and treatment options should be considered carefully. In symptomatic cases, total excision of the cyst should be considered the gold standard of treatment. We believe that the closure of the dural defect should be the main surgical goal to prevent recurrence. We propose laminoplasty for the treatment of extradural arachnoid cysts that involve multiple segments to prevent postoperative kyphosis.

Surgical Removal of Spinal Mass Lesions with Open Door Laminoplasty

OBJECTIVE The open door laminoplasty technique has been previously used to treat cervical spondylotic myelopathy. We adapted this technique for the removal of spinal tumors all along the spinal axis. METHODS Between January 2002 and January 2003, 17 patients with various intraspinal lesions underwent open door laminoplasty. The thoracal level was involved in 10 cases, the cervical level in 3 patients and the lumbar level in 4. Location of the tumor was intradural-intramedullary in 7, intradural-extramedullary in 6 and extradural in 4 patients. The histological diagnoses were 4 astrocytomas, 2 meningiomas, 3 neurinomas, 2 ependymomas and one case each with Ewings sarcoma, metastasis, abcess, hemangioblastoma, arachnoid cyst and lipoma. RESULTS All lesions were exposed using the open door laminoplasty technique and were successfully removed for intraspinal mass lesions. An average of 3.7 level laminoplasty was performed. Neither spinal malalignment on the coronal plane nor displacement of bone flap (laminoplasty flap) were observed on postoperative CT and MR examinations. No complications due to laminoplasty were encountered. The mean follow-up was 30 months (range 22-48 months). CONCLUSION Open door laminoplasty is a simple procedure and has two main advantages over the classical laminectomy procedure; a lower incidence of spinal deformities with or without neurological deficits and an absence of epidural scar tissue. This procedure can be used in all spinal cases with intraspinal mass lesions.

Pineal epidermoid tumors: report of five cases.

AIM The aim of this study was to retrospectively analyse the clinical, radiological features and surgical outcome of pineal epidermoid tumors treated at a single neurosurgical department. MATERIAL AND METHODS We performed surgery on five patients with pineal region epidermoid tumors at a single neurosurgical department between the years 1998 and 2006. Headache, diplopia and ataxia were the most common presenting findings. Parinauds syndrome was found in three patients. Hydrocephalus was demonstrated radiologically in two patients. RESULTS Two patients were operated on with the occipital-transtentorial approach, two were operated on with the infratentorial-supracerebellar approach and one was operated on with van Wagenens approach. Recurrence of tumor was observed in one patient. One patient died at the first postoperative month due to ventriculitis. CONCLUSION Total removal of epidermoid tumors may provide good clinical recovery and may reduce the possibility of tumor recurrence and shunt placement.

Evaluating the factors affecting cerebral vasospasm in patients after aneurysmal subarachonoid haemorrhage

Background Neurological deterioration from cerebral vasospasm is the most important cause of mortality and morbidity after subarachnoid haemorrhage (SAH). Symptomatic vasospasm occurs in 17 to 40% of patients with aneurysmal SAH and worsens their clinical outcome.

Matrix metalloprotease-9 expresssion in meningioma: Correlation with growth fraction and role of gender. A pilot immunohistochemical study

OBJECTIVE Matrix metalloproteases (MMPs), particularly MMP2 and MMP9 increase tumor invasion and edema in meningiomas. Although lesser recognized, MMPs may also enhance cell growth via liberating growth factors or via cleaving inactive growth factors into active isoforms. However, there exist very few studies, which investigated correlation of MMPs with growth fraction in meningiomas. Meningiomas are seen more frequently in women and their growth accelarate during pregnancy. However, no study examined whether MMP-expressions in meningioma differ with gender. PATIENTS AND METHODS In a pilot immunohistochemical study, we analyzed the correlation of MMP9 expression with Ki67 index and whether gender influences MMP9 expression. We retrospectively selected 24 meningioma cases including 10 cases with WHO Grade-1 tumors and 7 cases each with WHO Grade-2 and 3 tumors, respectively. RESULTS We separately determined the intensity and area of MMP9 staining and also calculated an expression index by multiplying these two parameters. Spearman correlation analyses revealed that MMP9 staining intensity, staining area and expression index significantly correlated with Ki67 proliferation index. MMP9 staining indices were significantly higher in women specimens. CONCLUSION If these findings will be confirmed in larger series, MMP-inhibitors and female hormone receptor-antagonists may be combined to augment chemotherapy efficacy and to attenuate invasion in high-grade meningiomas.