Cengiz Çokluk

Morphometry of the thoracolumbar vertebrae in sickle cell disease

Patients with sickle cell disease (SCD) who have deformities and vertebral fractures due to osteoporosis may require surgery. Spinal surgeons must become familiar with the vertebral morphometry of patients with SCD and to that aim we have examined the morphometry of the thoracolumbar spine in these patients. A cohort of 100 patients with SCD was examined using plain thoraco lumbar anteroposterior/lateral radiographs and dual energy X-ray absorptiometry (DEXA). Vertebral morphometry (vertebral body diameters, pedicle, spinal canal and deformity) was assessed for different age groups. Results were compared to published studies of healthy subjects. The vertebral dimensions for the 16-20-year and the 21+-year-old groups were significantly smaller for females than males at most spinal levels, while measurements in the 6-10 years and 11-15 years age groups were similar across both sexes at most levels. No significant statistical difference was found between the diameters of the right and left pedicles. With the exception of the sagittal diameter, most of the dimensions of the vertebral bodies measured in SCD patients were less than those of healthy individuals; multiple deformities were also observed. Low bone density was noted in 32 patients. Our data highlight the differences in vertebral bone mineral density, anatomy and deformities in patients with SCD compared to healthy individuals. When considering surgical intervention for patients with SCD, it is important that pre-operative radiography and planning is undertaken, and that the surgeon is familiar with the geometry of the pedicles of the thoracolumbar vertebrae necessary for the safe insertion of pedicle screws. Osteoporosis must be considered when planning surgical interventions in these patients.

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.

Hippocampal cell loss after an anterior and posterior anastomotic vein occlusion model in rats

Estimation of the cell number after cortical venous ischemia/infarction induced by anterior and posterior anastomotic veins occlusion in a rat model is very important. Twenty male Sprague‐Dawley rats were used in this experiment. Small burr‐holes were made over the anterior (the crossing point of the line drawn from the posterior border of the orbital rim and the line drawn along the para‐midline to the superior sagittal suture) and posterior (just inferior point of the posterior ending of the zygomatic arch) anastomotic veins. Bipolar coagulation technique and micro‐scissor were used to sacrifice the venous vessels after final inspection and description. Specimens were evaluated by histopathological and unbiased stereological methods for microscopic evaluation and volumetric analysis, respectively. Significant cell loss was seen in the pyramidal and granule cells of the cornu ammonis and dentate gyrus of the hippocampus after venous ischemia. Cell loss was also pronounced when seen in the histological examination. The present results suggest that the sacrifice of anterior and posterior anastomotic veins can be used as an experimental rat model in the evaluation of pyramidal and granule cell loss in the hippocampus that often assesses the neural damage inflicted by this intervention.

Cortical anastomotic veins occlusion in the rat including the assessment of cerebral swelling.

A rat model composed of the sacrifice of the anterior and posterior cortical anastomotic veins by microsurgical techniques was used for the assessment of brain swelling. Twenty male, 15-week-old Sprague-Dawley rats were used in this animal experiment. Small burr-holes were made over the anterior (the intersection of the line drawn from the posterior border of the orbital rim and the line drawn along the para-midline to the superior sagittal suture) and posterior (inferior point of the posterior end of the zygomatic arch) anastomotic veins. After performing a final inspection and describing the venous vessels, they were sacrificed using bipolar coagulation technique and micro-scissors. Specimens were evaluated using histopathological approach, albumin immunostaining technique and a stereological method. Hemispheric swelling, midline shift, brain oedema, subcortical petechial haemorrhagia, ischemia and necrosis were histopathological findings observed in this experimental study. The albumin immunostaining study demonstrated disrupted areas of the blood-brain barrier in the operated hemisphere. Stereological volumetric analysis revealed an 8% brain swelling in the operated hemispheres compared with unoperated ones. Our results suggest that the sacrifice of the anterior and posterior anastomotic veins may be used as an experimental rat model in the evaluation of brain damage and swelling caused by the occlusion of the venous anastomotic outflow.

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.

Is there a relationship between serum heart- type fatty acid binding protein level and clinical severity in patients with subarachnoid hemorrhage?

AIM The aim of this study was to determine the serum heart-type fatty acid binding protein (H-FABP) levels and cardiac effects in patients presenting with subarachnoid hemorrhage (SAH) and to investigate whether any correlation exists between the cardiac effects and H-FABP. MATERIAL AND METHODS Forty-six patients diagnosed as acute SAH in the emergency department were included in this study. Twenty healthy adults were included in the study to serve as controls. Twelve-lead ECG was performed on all patients on admission. H-FABP levels of patients were determined in serum samples taken on admission. RESULTS Serum H-FABP levels of patients were found to be significantly higher than those of controls (p < 0.05). There was no significant correlation between serum H-FABP levels and ECG changes. There was a moderate positive correlation between H-FABP serum levels and the grade according to the Hunt and Hess classification (r=0.43, p < 0.05). There was a weak positive correlation between H-FABP serum levels and the grade according to the Fisher radiological classification (r=0.38, p < 0.05). CONCLUSION Serum H-FABP levels are increased in patients with SAH. Grades according to the Hunt and Hess and Fisher grading scales were shown to increase in conjunction with an increase in H-FABP levels.

Use of topical landmarks for percutaneous projection of intracranial tumors for neurosurgical oncology.

AIM The objective of this study was to introduce a surgical navigation method which provides a safe, quick and effective access to cortical and subcortical tumors, along with a review of other methods in use for this purpose. MATERIAL AND METHODS 53 patients have been operated using this technique. The area overlying the tumor is shaved and one half of a smoothly cut hazelnut is taped on the skin. The precise localization of the hazelnut is confirmed with MRI and then stained. After general anesthesia, the stained impression is projected firstly to the bone, dura and then cortex respectively by the Midas Rex cutting tip. Cortical landmarks surrounding the tumors cortical projection are further confirmed with ultrasonography. RESULTS After removal, cortical and subcortical tumors were separately graded for efficiency. Grade 1 and 2 were accepted as precise access. Our method accordingly yielded 95.2% and 90.6% success rates for cortical and subcortical tumors respectively. CONCLUSION Considering the methods success rate along with its inexpensiveness and modest technical requirements, it is believed that this method can be of widespread use.

Localization of Intracranial Lesions Using Superficial Stereotaxic Cranial Lesion Locator Based on Magnetic Resonance Images

Background. Detection of a deep-seated lesion located in the brain parenchyma and major neuroanatomical sites is a critical issue in neurosurgery. Some neurosurgical cranial navigation systems have been developed that are available; however, some preparation is necessary, including the installation of complex computer software programs and obtaining specific neuroradiological images. Objective. The purpose of this experimental study was to design and evaluate a superficial stereotaxic frameless lesion locator in order to localize mass lesions within the brain. Methods. A superficial stereotaxic frameless lesion locator system was designed using cardboard and the Cartesian coordinate system as a reference framework. This material was used in a model creating printed magnetic resonance images in the superficially marking of the lesion. This material easily located the lesion placement and superficially projected the lesion location. Results. The results of this study revealed that the superficial stereotaxic frameless lesion location procedure using a coordinate cardboard locator is a safe, fast, and simple procedure. This procedure provides an accurate means of locating the target lesion seated within the brain parenchyma. When compared with other models, we found that this device is reliable and has a high rate of superficial lesion detection. Conclusion. A superficial lesion locator may be used in clinical practice. This experimental study demonstrated the usability and reliability of the procedure. Additional detailed investigations are necessary to improve the procedure.