Omer Faruk Unal

Fully Endoscopic Interlaminar and Transforaminal Lumbar Discectomy: Short-Term Clinical Results of 163 Surgically Treated Patients

OBJECTIVE To evaluate the clinical outcomes of patients with lumbar disc disease undergoing fully endoscopic surgery at a single clinic. METHODS Between August 2009 and January 2012, 163 patients (74 men and 89 women) underwent fully endoscopic lumbar discectomy. All patients were followed for 1 year after surgery. The Oswestry Disability Index and a visual analog scale were used to analyze outcomes. RESULTS During the follow-up period, 114 (70%) patients had no complaints, 30 (18%) patients had occasional pain, and 19 (12%) patients had no improvement. During postoperative follow-up, 8 patients required repeat surgery for recurrence or residual fragments. Postoperatively, 4 patients experienced dysesthesia, which completely resolved in time. Neurologic deterioration occurred in 5 patients, 4 of whom recovered completely without any intervention. Dural tears occurred in 6 patients. CONCLUSIONS Fully endoscopic interlaminar or transforaminal surgeries are safe and effective treatment modalities for lumbar disc herniations. Despite the difficulties of acquiring this new technique, good results can be achieved with sufficient experience.

Bone marrow necrosis secondary to imatinib usage, mimicking spinal metastasis on magnetic resonance imaging and FDG-PET/CT

Imatinib mesylate has become the treatment of choice for gastrointestinal stromal tumors (GISTs) and has made a revolutionary impact on survival rates. Bone marrow necrosis is a very rare adverse event in malignant GIST. Bone metastases are also rarely encountered in the setting of this disease. The authors report on a patient with malignant GIST who developed a bone lesion, mimicking spinal metastasis on both MR imaging and FDG-PET/CT. Corpectomy and anterior fusion was performed, but the pathology report was consistent with bone marrow necrosis. Radiological and clinical similarities made the distinction between metastasis and bone marrow necrosis challenging for the treating physicians. Instead of radical surgical excision, more conservative methods such as percutaneous or endoscopic bone biopsies may be more useful for pathological confirmation, even though investigations such as MR imaging and FDG-PET/CT indicate metastatic disease.

Emergency management of an acute tension pneumocephalus following ventriculoperitoneal shunt surgery for normal pressure hydrocephalus.

Tension pneumocephalus is a rare and life threatening complication of intracranial surgical procedures, and requires immediate recognition and surgical intervention. Tension pneumocephalus following ventriculoperitoneal shunt surgery is extremely rare and commonly seen as a delayed complication. To our knowledge, early postoperative tension pneumocephalus after shunt surgery was reported only in one other publication. We present a case of acute tension pneumocephalus following ventriculoperitoneal shunt surgery for normal pressure hydrocephalus, which was managed well with close neurological follow-up and rapid surgical intervention. The use of the portable CT scanner in this case saved significant time, without the transport of the patient to the radiology unit, made early surgical intervention possible, and prevented morbidity and mortality.

Neuronavigation-assisted percutaneous balloon compression for the treatment of trigeminal neuralgia: The technique and short-term clinical results

Abstract Background. Percutaneous balloon compression (PBC) has been widely used in the treatment of trigeminal neuralgia. However, this technique has a steep learning curve and significant complications were reported that were related to foramen ovale puncturing. The aim of this study was to evaluate the clinical results of a small patient group who underwent neuronavigation-assisted PBC. Methods. An intraoperative computed tomography (CT) device (CereTom, Neurologica, Danvers, MA/USA) was used to obtain CT scans with 2-mm slice thicknesses. The data were transferred to a neuronavigation system planning station (BrainLab, Feldkirchen, Germany). A soft touch registration system was used for image registration. With the image guidance, a trajectory was defined and the foramen ovale was cannulated using neuronavigation and Hartels landmarks. Results. Sixteen procedures were performed on 13 patients (4 female and 9 male) without complications. The total length of the procedure was not more than 57 min in all instances. Conclusions. We believe that image-guided neuronavigation is useful for neurosurgeons who are at the beginning of their PBC learning curve. It may also be an alternative for particular patients with significant anatomic variations that result in an unsuccessful foramen ovale puncture.

Clinical course of nontraumatic nonaneurysmal subarachnoid hemorrhage: a single institution experience over 10 years and review of the contemporary literature

AIM To report our experience with a relatively large series of patients with non-traumatic non-aneurysmal subarachnoid hemorrhage (NNSAH) to identify the prognosis associated with different bleeding patterns as well as a further diagnostic work-up to determine the underlying cause. MATERIAL AND METHODS Between January 2004 and December 2014, 81 patients with angiography-negative non-traumatic subarachnoid hemorrhage (SAH) were treated at our institution. Diagnosis was confirmed with a typical history of spontaneous SAH and cranial computed tomography (CT) scan or lumbar puncture (LP). The patients were grouped according to the bleeding pattern on the CT scan: Group 1: Perimesencephalic (PM) SAH (n=33, 40.7%); Group 2: Non-perimesencephalic (nPM) SAH (n=41, 50.6%); and Group 3: CT-negative NNSAH (n=7, 8.6%). The clinical course, hospitalization period, and complications were noted. All patients underwent an initial four-vessel digital subtraction angiography (DSA). Cranial magnetic resonance imaging (MRI), repeat DSA investigations and spinal MRI were performed in all patients. RESULTS The mean hospital stays were 6.3, 14.7 and 10.1 days for patient groups 1, 2, and 3, respectively. The mortality rate was 1.2% (1 patient) in our series. Repeat DSA investigations were positive in two patients (2.5%), both from Group 2 (4.9%). Cranial MRI revealed 100% negative results. Spinal MRI revealed positive results in three patients from Group 2 (7.3%). CONCLUSION We suggest our diagnostic work-up for patients with nPM-SAH, namely repeat DSA and spinal MRI, until an evidence-based guideline is established for the patient management.

Ascending transaqueductal cystoventriculoperitoneal shunting in Dandy-Walker malformation: technical note.

The optimal treatment for Dandy-Walker malformation is still controversial. Ventriculoperitoneal shunting, cystoperitoneal shunting or combinations are the most common surgical options in the management of this clinical entity. Endoscopic procedures like ventriculocystostomy, 3rd ventriculostomy or endoscopy-assisted shunt surgeries have become the focus of recent publications. We describe a new transcystic endoscopic technique, with the usage of a single ascending transaqueductal shunt catheter with additional holes, whereby both the posterior fossa cyst and supratentorial ventricular compartments are drained effectively. By using this new technique complications associated with combined shunting can be avoided. In addition, by equalizing the pressure within the supra- and infratentorial compartments, the upward or downward herniations associated with single-catheter shunting can be prevented.

Magnetic resonance imaging characteristics of cardiac hydatid cyst

PURPOSE The purpose of this article is to describe the magnetic resonance imaging (MRI) features of cardiac hydatid disease and show the specific findings in the diagnosis of hydatic cysts. MATERIALS AND METHODS A retrospective review of cardiac MRI records between 2015 and 2017, 7 patients (3 males, 4 females; age range: 14-74) were identified with the histologic diagnosis of cardiac hydatid disease. Cardiac MRI examinations were performed in order to investigate the cardiac cystic-solid lesion obtained via previous echocardiography (ECG) and thorax computed tomography. 1.5 Tesla magnetic field power generation capacity was used and the images were acquired with ECG trigger. RESULTS There is variation in signal characteristics of cysts on T1-weighted and T2-weighted images. Early contrast enhancement was not observed in the any of lesions on contrast-enhanced series. In all lesions examined, peripheral contrast enhancement was observed in the late contrast enhanced series, independent from the internal structure and signal intensity. CONCLUSIONS MRI reveals the exact anatomic location and nature of the cyst structures. Peripheral enhancement of non-enhancing lesion is very valuable for diagnosis of cardiac hydatids on MRI.

Memantine and Q-VD-OPh Treatments in Experimental Spinal Cord Injury: Combined Inhibition of Necrosis and Apoptosis.

AIM To evaluate the effects of NMDA receptor antagonist memantine and pancaspase inhibitor Q-VD-Oph in combination or alone in experimental spinal cord injury. MATERIAL AND METHODS 45 male Sprague-Dawley rats were divided into five groups. Spinal cord injury was created with the clip compression technique. The drugs were administered either alone of in combination to the subjects according to their groups. Motor function was assessed with Tarlovs motor grading scale and the inclined plane technique. The subjects were sacrificed at the fifth postoperative day. Histopathological examination was done with the use of hematoxylin eosin and TUNEL staining. RESULTS The results for TUNEL staining and apoptotic cell counts revealed statistically significant differences in Q-VD-Oph and combined treatment groups. Tarlov motor grading scale and inclined plane test results were also found significantly better in these two groups. CONCLUSION Combined use of memantine and Q-VD-OPh provides better histological and clinical results. The combined inhibition of the two major pathways, necrosis and apoptosis, needs to be further assessed with in-vivo or in-vitro studies.