Browsing by Author "Kocaeli, Hasan"
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Item Akut lenfoblastik lösemili bir olguda gelişen nöroaspergillozun başarılı tedavisi: Cerrahi, sistemik antifungal tedavi ve intrakaviter tedavinin rolleri(Ankara Mikrobioloji Derneği, 2009-07) Özçelik, Tülay; Özkalemkaş, Fahir; Kocaeli, Hasan; Altundal, Yıldız; Ener, Beyza; Ali, Rıdvan; Özkocaman, Vildan; Hakyemez, Bahattin; Tunalı, Ahmet Semih; Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Beyin Cerrahisi Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; 0000-0002-4803-8206; 0000-0002-3425-0740; AAG-8523-2021; X-3647-2018; AAI-2318-2021; AAH-1854-2021; AAG-8495-2021; 7005424333; 6601912387; 6603500567; 15080726300; 15053025300; 7201813027; 6603145040; 6602527239; 6602797853Serebral aspergilloz nadir bir durum olup konvansiyonel antifungal tedavilere genellikle kötü yanıt vermektedir. Bu raporda, 34 yaşında akut lenfoblastik lösemi tanısı olan bir erkek hastada agresif nörocerrahi, intrakaviter amfoterisin B tedavisi ve vorikonazol kombinasyonu ile başarıyla tedavi olan bir serebral aspergilloz olgusu sunulmuş ve nöroaspergillozun tedavisinde cerrahi tedavi, intrakaviter tedavi ve antifungal tedavinin rolleri tartışılmıştır. Amfoterisin B tedavisi altında dizartri ve sağ hemiparazi gelişen olgumuzda beyin manyetik rezonans görüntülemede sol paryeto-oksipital bölgede 7 cm çapında lezyon saptanmıştır. Tanı amaçlı yapılan cerrahi girişim aşırı kanama nedeniyle başarıyla gerçekleştirilememiştir. Lezyondan alınan aspirat örneğinin kültüründe Aspergillus flavus üremesi saptanmıştır. Tedavi kaspofungin ve vorikonazol kombinasyonu olarak değiştirilmiştir. Tedavi altında enfeksiyonun ilerleme göstermesi üzerine hastaya ikinci cerrahi girişim uygulanmış ve lezyonun boyutunda gerileme tespit edilmiştir. Cerrahi tedaviyi takiben vorikonazol ve kaspofungin kombinasyon tedavisine ek olarak intrakaviter amfoterisin B uygulaması yapılmıştır (0.3 mg/gün 15 gün). Kaspofungin tedavisine 42 gün devam edildikten sonra kesilmiştir. Vorikonazol tedavisine ise 100 gün devam edilmiştir. Bu dönemde beyindeki lezyon tama yakın düzelme göstermiştir. Ancak, hastanın takibi sırasında lösemi relapsı görülmüş ve kemoterapi sırasında aplazik dönemde gelişen nötropenik tiflitis tablosu ile hasta kaybedilmiştir. Serebral aspergillozlu olgularda erken dönemde radikal cerrahi uygulanması sonucunda daha iyi sonuçlar elde edildiği belirtilmektedir. Antifungal tedavide kullanılan ilaçların vorikonazolde olduğu gibi kan-beyin bariyerini geçebilme özelliğine sahip olması gerekmektedir. Tüm lezyonlar düzelinceye ve altta yatan predispozan faktörler geri dönünceye kadar tedaviye devam edilmelidir. Sonuç olarak, serebral aspergillozlu olgularda cerrahi girişim ve vorikonazol tedavisinin güvenilir ve etkin tedavi yaklaşımları olduğu düşünülmüştür.Item Analysis of intracranial pressure changes during early versus late percutaneous tracheostomy in a neuro-intensive care unit(Springer, 2008-12) Kocaeli, Hasan; Korfali, Ender; Taşkapilioğlu, Özgür; Özcan, Tekin; Uludağ Üniversitesi/Tıp Fakültesi/Nöroşirürji Anabilim Dalı.; V-1196-2018; 6603500567; 7004641343; 6506852772; 25636374000Background We aimed to investigate intracranial pressure (ICP) changes during early versus late bedside percutaneous tracheostomy (PT) in a neuro-intensive care unit (NICU). Methods This study included 30 patients admitted to our NICU for head trauma, subarachnoid haemorrhage, intracerebral haematoma or brain tumour with a Glasgow Coma Score (GCS) less than 8. These patients also underwent ICP monitoring. Bedside PT was performed either early (within 7 days of ventilation) or late (after 7 days of ventilation) via the Griggs system. In all patients; ICP, systemic blood pressure, heart rate, oxygen saturation (Sat O(2)) and arterial blood gases were recorded 5 min before the procedure, during skin incision, during tracheal cannulation, as well as 5 min and 10 min after the procedure. Findings Thirty patients, 18 male and 12 female, with various intracranial pathologies between ages 18 and 78 (mean 38.7 +/- 20) were identified. The admission GCS ranged between 4 and 11 (median 7). Physiological variables did not differ significantly between the two groups. In the early group, ICP values measured 5 min before the procedure, during skin incision, during tracheal cannulation, as well as 5 min and 10 min after the procedure were 15.1 +/- 5.2, 22 +/- 10.1, 28.4 +/- 13.7, 17.3 +/- 7.1, 13.8 +/- 5.0 mmHg, respectively. In the late group, these values were 14.2 +/- 4.5, 17.2 +/- 5.5, 21.5 +/- 8.0, 15.1 +/- 5.3 and 12.4 +/- 4.1 mmHg. There was no significant difference between the early or late groups in terms of ICP increases during these predetermined 5 time points. Conclusions In patients with decreased intracranial compliance, a relatively minimally invasive procedure such as PT may lead to significant increases in ICP. The timing of PT does not seem to influence ICP, mortality, pneumonia or early complications. During the PT procedure, ICP should be closely monitored and preventive strategies should be instituted in an attempt to prevent secondary insult to an already severely injured brain.Item The artery of Percheron revisited: A cadaveric anatomical study(Springer Wien, 2013-03) Kocaeli, Hasan; Yılmazlar, Selçuk; Kuytu, Turgut; Korfalı, Ender; Uludağ Üniversitesi/Tıp Fakültesi/Nöroşirürji Anabilim Dalı.; 0000-0003-3633-7919; AAH-5070-2021; 6603500567; 6603059483; 36548277700; 7004641343The artery of Percheron (AOP) is a single thalamoperforating arterial trunk that provides bilateral supply to the paramedian thalami and the rostral midbrain. As this rare anatomical variant artery may be involved in endovascular procedures or encountered surgically during basilar terminus aneurysms, the present study was warranted. Thirty-four adult (20 male and 14 female) formalin-fixed cadaveric brains underwent dissection of the 68 posterior cerebral arteries. Observations were made of the presence and the variations of the thalamoperforating arteries as well as the presence of the AOP. Thalamoperforating arteries arose from the superior or posterior surfaces of the P1 segment at a mean of a 1.87 mm (range, 0.39-5.25 mm) distance from the basilar apex and entered the brain through the posterior perforated substance. The average number was 4.25 (range 1-9), and the mean diameter was 0.73 mm (range 0.46-1.16 mm). Thalamoperforating arteries were classified into four different types according to their origin at the P1 segment: type I (bilateral multiple, n = 19), 55.8 %; type II (unilateral multiple, unilateral single, n = 4), 11.7 %; type III (bilateral single, n = 7), 20.5 %; type IV [one side with a single branch, the other side with no branches (the AOP), n = 4], 11.7 %. In three separate specimens with ruptured basilar artery aneurysms, the origin of the thalamoperforating arteries was incorporated not only into the posterior aspect of the aneurysm neck but also into the fundus. In about one tenth of cases the possibility of the presence of a single arterial trunk that supplies the two paramedian thalamic territories should be taken into consideration during treatment planning of basilar terminus aneurysms. Furthermore, our data show that the thalamoperforating arteries may take off from both the aneurysm neck and the fundus.Item Assesment of perfusion in glial tumors with arterial spin labeling; comparison with dynamic susceptibility contrast method(Elsevier Ireland, 2014-10) Öztürk, Esin Işık; Gümüş, Caner; İnecikli, Mehmet Fatih; Cebeci, Hakan; Aydın, Ömer; Bekar, Ahmet; Kocaeli, Hasan; Hakyemez, Bahattin; Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Beyin ve Sinir Cerrahisi Anabilim Dalı.; 0000-0002-3425-0740; AAI-2318-2021; 56033553000; 55933661900; 6603677218; 6603500567; 6602527239Purpose: Arterial spin labeling perfusion imaging (ASL-PI) is a non-invasive perfusion imaging method that can be used for evaluation and quantification of cerebral blood flow (CBF). Aim of our study was to evaluating the efficiency of ASL in histopathological grade estimation of glial tumors and comparing findings with dynamic susceptibility contrast perfusion imaging (DSC-PI) method. Methods: This study involved 33 patients (20 high-grade and 13 low-grade gliomas). Multiphase multislice pulsed ASL MRI sequence and a first-passage gadopentetate dimeglumine T2*-weighted gradient-echo single-shot echo-planar sequence were acquired for all the patients. For each patient, perfusion relative signal intensity (rSI), CBF and relative CBF (rCBF) on ASL-PI and relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) values on DSC-PI were determined. The relative signal intensity of each tumor was determined as the maximal SI within the tumor divided by SI within symetric region in the contralateral hemisphere on ASL-PI. rCBV and rCBF were calculated by deconvolution of an arterial input function. Relative values of the lesions were obtained by dividing the values to the normal appearing symmetric region on the contralateral hemisphere. For statistical analysis, Mann-Whitney ranksum test was carried out. Receiver operating characteristic curve (ROC) analysis was performed to assess the relationship between the rCBF-ASL, rSI-ASL, rCBV and rCBF ratios and grade of gliomas. Their cut-off values permitting best discrimination was calculated. The correlation between rCBV, rCBF, rSI-ASL and rCBF-ASL and glioma grade was assessed using Spearman correlation analysis. Results: There was a statistically significant difference between low and high-grade tumors for all parameters. Correlation analyses revealed significant positive correlations between rCBV and rCBF-ASL (r=0.81, p<0.001). However correlation between rCBF and rCBF-ASL was weaker (r=0.64, p<0.001). Conclusion: Arterial spin labeling is an employable imaging technique for evaluating tumor perfusion non-invasively and may be useful in differentiating high and low grade gliomas.Item Bilateral high-level percutaneous cervical cordotomy in cancer pain due to lung cancer: A case report(Elsevier Science, 2006-07-11) Bekar, Ahmet; Kocaeli, Hasan; Abaş, Faruk; Bozkurt, Merlin; Uludağ Üniversitesi/Tıp Fakültesi/Beyin ve Sinir Cerrahisi Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.; 6603677218; 6603500567; 8546184300; 16202046200Background: Computed tomography–guided high-level percutaneous cordotomy has been used unilaterally or bilaterally for the treatment of localized intractable pain in malignancies. Case Description: A 57-year-old man was admitted to the hospital with the complaint of intractable pain involving the left side of the chest, axillary region, and shoulder. He was operated for small cell lung cancer on the left side in December 2003 and received radiotherapy and chemotherapy. His neurological examination was normal. Magnetic resonance imaging of the thorax revealed contrast- enhancing lesions on the left side extending to mediastinum and pleura. His pain was relieved completely after the first cordotomy procedure, and he was discharged from the hospital on the second postoperative day. The patient was readmitted to the hospital with the complaint of severe unilateral chest pain like the initial pain on the right side 4 days after cordotomy. The CT-guided bilateral high-level percutaneous cordotomy was performed with a 15-day interval. Conclusion: The CT-guided bilateral high-level percutaneous cordotomy can be used in the treatment of intractable upper trunk pain in patients with cancer without pulmonary dysfunction.Item Brain stem stroke associated with epidermoid tumours: Report of two cases(BMJ Publishing Group, 2004-09) Yılmazlar, Selçuk; Kocaeli, Hasan; Cordan, Teoman; Uludağ Üniversitesi/Tıp Fakültesi/Beyin ve Sinir Cerrahisi Anabilim Dalı.; 0000-0003-3633-7919; AAH-5070-2021; 6603059483; 6603500567; 7801648865Two cases of cerebello-pontine angle epidermoid tumour presented with the clinical findings of brain stem stroke. Preoperative imaging showed stretching of branches of the basilar artery. Brain stem stroke as a presenting feature of cerebello-pontine angle epidermoid tumour has not been reported before.Item Broca alanının topografik anatomisinin incelenmesi: Kadaverik anatomik çalışma(Uludağ Üniversitesi, 2013) Eser, Pınar; Kocaeli, Hasan; Uludağ Üniversitesi/Tıp Fakültesi/Beyin ve Sinir Cerrahisi Anabilim Dalı.Broca alanında lisan yeteneğiyle ilgili yapısal asimetri tartışmalıdır. `Broca alanı olarak kabul edilen pars triangularis ve pars operkularis yapısına katılan sulkuslar, bireyler hatta aynı beynin farklı hemisferleri arasında oldukça yaygın anatomik ve morfolojik varyasyonlar gösterir. Bu çalışmada, pars triangularis ve pars operkularis arasındaki morfolojik asimetriyi oluşturan sulkal yapıların varlığı, devamlılığı ve bağlantıları incelendi. Broca alanı ve sağ hemisferdeki homolog bölgenin yüzey alanı ölçümü yapılarak; cinsiyet farkının, pars triangularis şekli ve diagonal sulkus varlığı gibi anatomik varyasyonların yüzey alanı üzerindeki etkilerini analiz etmek amaçlandı. Çalışmamızda, kadavralardan elde edilen 50 beyin, 100 hemisfer kullanıldı. Beyinler, hazırlık aşamasından sonra cerrahi mikroskop altında incelenerek ilgili anatomik bölge fotoğraflandı. Photoscape 3.5.6 programı kullanılarak ilgili sulkal ve giral yapılar işaretlendi. Çekilen ölçekli fotoğraflarda Adobe Acrobat XI Pro programı kullanılarak yüzey alanı ölçümü yapıldı ve veriler istatistiksel olarak analiz edildi. İnferior frontal girus, ilgili sulkal ve giral yapılarda yaygın bireysel anatomik ve morfolojik varyasyon saptandı. Sol hemisferde diagonal sulkus varlığı anlamlı olarak yüzey alanını arttırdı. Taraf, pars triangularis şekli ve cinsiyet farklılığı yüzey alanına anlamlı oranda etki etmedi. Bu bölge ve komşu yapıların anatomi ve varyasyonlarının bilinmesi güvenli cerrahi için zorunludur. Bu çalışmada sağ ve sol taraf arasında yüzey alanı açısından fark saptanmadı. Diagonal sulkus varlığının yüzey alanını arttırdığı tespit edildi. Ancak, hemisferler arasında diagonal sulkus varlığı açısından anlamlı fark olmadığından; bu bulgu Broca alanı için yapısal asimetriyi desteklememektedir.Item CDP-choline and its endogenous metabolites, cytidine and choline, promote the nerve regeneration and improve the functional recovery of injured rat sciatic nerves(Taylor & Francis, 2011-09) Ulus, İsmail Hakkı; Arslan, Erhan; Kocaeli, Hasan; Bekar, Ahmet; Tolunay, Şahsine; Uludağ Üniversitesi/Tıp Fakültesi/Nöroşirürji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Patoloji Anabilim Dalı.; AAI-1612-2021; 7004957314; 6603500567; 6603677218; 6602604390Objective: Topical cytidine-5'-diphosphocholine (CDP-choline) has been shown to improve the functional recovery and promote the nerve regeneration of injured sciatic nerves in rats. The aims of this study were to test whether CDP-choline was effective at promoting nerve healing when the surgery to repair an injury was delayed and to determine whether the cytidine and/or the choline moieties of CDP-choline contribute to its beneficial actions. Methods: One hundred and fifty Sprague-Dawley rats underwent a surgical procedure that involved damaging the right sciatic nerve and suturing the epineurium. The injured sciatic nerve was either repaired immediately (on the first day) or on the third day after surgery. Rats were assigned to one of five groups and received a topical application of either 0.4 ml of saline (control) or 0.4 ml of 100 mu M CDP-choline, cytidine, choline, or cytidine+choline. Results: The sciatic function index (SFI) of the rats in both groups (those who had their nerve repair immediately versus those on day 3) improved gradually by 4, 8, and 12 weeks after surgery. The percentage recovery in SFI score was significantly higher in rats treated with CDP-choline or cytidine+choline at all time points. Axon count increased by similar to 50% in rats treated either with CDPcholine or cytidine+choline. Treatment with CDP-choline or cytidine+choline reduced scar formation and decreased nerve adherence when the sciatic nerve was repaired immediately, and rats treated with CDPcholine or cytidine+choline had better axonal organization than control rats. Treatment with choline or cytidine alone led to a less marked improvement in SFI score and failed to increase axon count. Conclusion: Our results demonstrate that CDP-choline, as well as the combination of its metabolites, cytidine+choline, improves the functional recovery and promotes the regeneration of injured sciatic nerves treated with immediate or delayed surgical repair in rats.Item Cerebellar granulocytic sarcoma: A case report(Galenos Yayıncılık, 2012-06) Tüzüner, Nükhet; Baytan, Birol; Evim, Melike Sezgin; Güneş, Adalet Meral; Kocaeli, Hasan; Balaban, Şaduman; Korfalı, Ender; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Hematolojisi Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Beyin Cerrahisi Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Patoloji Anabilim Dalı.; AAH-1452-2021; 6506622162; 36337796600; 24072843300; 6603500567; 55407231400; 7004641343Granulocytic sarcoma is a rare tumor composed of immature granulocytic cells that is usually associated with acute myelogenous leukemia. Intraparenchymal cranial localization without skull, meningeal, or bone marrow invasion is extremely rare. The mechanisms of intraparenchymal cranial localization of GS remains unknown, as only 10 cases with cerebellar granulocytic sarcoma have been previously reported. Herein, we report a four year old boy with cerebellar localization of granulocytic sarcoma.Item Cerebrospinal fluid leakage complicating skull base fractures: analysis of 81 cases(Springer, 2006) Yılmazlar, Selçuk; Arslan, Erhan; Kocaeli, Hasan; Doğan, Şeref; Aksoy, Kaya; Korfalı, Ender; Doygum, Muammer; Uludağ Üniversitesi/Tıp Fakültesi/Nöroşirürji Anabilim Dalı.; 0000-0003-3633-7919; AAH-5070-2021The aim of this study was to evaluate the results of conservative and surgical management options for traumatic cerebrospinal fluid (CSF) leakage complicating skull base fractures. The subjects were 81 patients who were treated between 1996 and 2003 for CSF leaks that had persisted for 24 h or longer after head injury. For each case the medical records were reviewed, and the data collected were as follows: demographic features, clinical and radiological findings, management options, complications and outcome scores. Analysis was done with patients grouped according to Glasgow coma scale (GCS) score at admission (<= 8 vs >8), and findings for three treatment methods (conservative, CSF drainage, surgery) were evaluated. In 32 cases (39.5%), the CSF leakage resolved spontaneously, and the mean hospital stay for these patients was 14 +/- 11 days. Twenty-four patients (29.6%) were treated by CSF drainage, and seven of these individuals ultimately required surgery to close the leak. Hospital stay was 17 +/- 7 days. Twenty-five patients (30.9%) underwent surgery as the initial treatment step, and the mean hospital stay for these individuals was 15 +/- 9 days. The large majority (74.2%) of patients with admission GCS scores <= 8 had poor outcomes. Compared with this group, a greater proportion of the CSF leaks in the patients with admission GCS scores >8 resolved spontaneously. The factors that had a critical influence on outcome in this series were level of consciousness on admission and presence of additional intracranial pathology associated with CSF leakage within cases of traumatic CSF fistulae due to skull base fractures. Treatment decisions should be dictated by the severity of neurological decline during the emergency period and the presence/absence of associated intracranial lesions. The timing for surgery and CSF drainage procedures must be decided with great care and with a clear strategy. The authors offer a treatment algorithm.Item Citicoline and postconditioning provides neuroprotection in a rat model of ischemic spinal cord injury(Springer Wien, 2010-06) Türkkan, Alper; Alkan, Tülin; Gören, Bülent; Kocaeli, Hasan; Akar, Eylem; Korfali, Ender; Uludağ Üniversitesi/Tıp Fakültesi/Beyin ve Sinir Cerrahisi Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Fizyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Patoloji Anabilim Dalı.; AAH-1792-2021; AAH-1718-2021; 25029159600; 6601953747; 6602543716; 6603500567; 26634688200; 7004641343Ischemic spinal cord injury is a chain of events caused by the reduction and/or cessation of spinal cord blood flow, which results in neuronal degeneration and loss. Ischemic postconditioning is defined as a series of intermittent interruptions of blood flow in the early phase of reperfusion and has been shown to reduce the infarct size in cerebral ischemia. Our study aimed to characterize the relationship between the neuronal injury-decreasing effects of citicoline and ischemic postconditioning, which were proven to be effective against the apoptotic process. Spinal cord ischemia was produced in rats using an intrathoracic approach to implement the synchronous arcus aorta and subclavian artery clipping method. In our study, 42 male Sprague-Dawley rats (309 +/- 27 g) were used. Animals were divided into sham operated, spinal ischemia, citicoline, postconditioning, and postconditioning citicoline groups. Postconditioning was generated by six cycles of 1 min occlusion/5 min reperfusion. A 600 mmol/kg dose of citicoline was given intraperitoneally before ischemia in the citicoline and postconditioning citicoline groups. All rats were sacrificed 96 h after reperfusion. For immunohistochemical analysis, bcl-2, caspase 3, caspase 9, and bax immune staining were performed. Caspase 3, caspase 9, bax, and bcl-2 were used as apoptotic and antiapoptotic markers, respectively. The blood pressure values obtained at the onset of reperfusion were significantly lower than the preischemic values. A difference in immunohistochemical scoring was detected between the caspase 3, caspase 9, bax, and bcl-2 groups. When comparisons between the ischemia (groups 2, 3, 4, and 5) and sham groups (group 1) were performed, a significant increase in caspase 3, caspase 9, bax, and bcl-2 was detected. When comparing the subgroups, the average score of caspase 9 was found to be significantly higher in ischemia group 2. The average score of bcl-2 was also found to be significantly higher in postconditioning and citicoline group 5. It is thus thought that combining citicoline with postconditioning provides protection by inhibiting the caspase pathway and by increasing the antiapoptotic proteins.Item Citicoline improves functional recovery, promotes nerve regeneration, and reduces postoperative scarring after peripheral nerve surgery in rats(Elsevier Science, 2007-12) Özay, Rafet; Bekar, Ahmet; Kocaeli, Hasan; Karlı, Necdet; Gülaydan, Filiz; Ulus, İ. Hakkı; Uludağ Üniversitesi/Tıp Fakültesi/Farmakoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Nöroşirurji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Nöropatoloji Anabilim Dalı.; D-5340-2015; 13906765700; 6603677218; 6603500567; 6506587942; 6602693514; 7004271086Results: In the control versus citicoline-treated rats, SFI was -90 +/- 1 versus -84 +/- 1 ( P < .001), -76 +/- 4 versus -61 +/- 3 (P < .001), and -66 +/- 2 versus -46 +/- 3 (P < .001) at 4, 8, and 12 weeks after surgery, respectively. At 12 weeks after surgery, axon count and diameter were 16400 +/- 600 number/mm(2) and 5.47 +/- 0.25 mu m versus 22250 +/- 660 number/mm(2) (p < .001) and 6.65 +/- 0.28 mu m (P < .01) in the control and citicoline-treated groups, respectively. In citicoline-treated rats, histomorphological axonal organization score at the repair site was (3.4 +/- 0.1) significantly better than that in controls (2.6 +/- 0.3) (P < .001). Peripheral nerve regeneration evaluated by EMG at 12 weeks after surgery showed significantly better results in the citicoline group (P < .05). Nerves treated with citicoline demonstrated reduced scarring at the repair site (P < .001). Conclusion: Our results demonstrate that citicoline promotes regeneration of peripheral nerves subjected to immediate section suturing type surgery and reduces postoperative scarring.Item Clinical and radiologic analysis of 3-level anterior cervical discectomy and fusion with interbody cages without plate fixation(Elsevier, 2008-02) Doǧan, Şeref; Türkkan, Alper; Kocaeli, Hasan; Korfali, Ender; Bekâr, Ahmet; Uludağ Üniversitesi/Tıp Fakültesi/Beyin Cerrahisi Anabilim Dalı.; AAI-6531-2021; 7102693077; 25029159600; 6603500567; 7004641343; 6603677218Objectives: The primary objective of this Study was to analyze the clinical and radiologic outcomes of 3-level anterior cervical discectomy and fusion procedures performed using interbody cages without plate fixation, Methods: Twenty-two patients with radiculomyelopathy were retrospectively evaluated. Functional Outcome of patients with radiculopathy was assessed using Odom's criteria, and myelopathic patients were rated according to Nurick's classification. Radiographs were used for evaluation of the cervical lordosis, fusion, foraminal height, and implant position. Results: An excellent or good functional result was found in all of the patients with radiculopathy. In addition, Nurick grades improved from a mean of 2.4 before surgery to a mean of 1.2 at follow-up (P = 0.007). These effects were accompanied by a significant increase in height of the foramina after surgery (P = 0.006). However, there was no statistically significant difference between cervical lordosis before Surgery and at final follow-Lip. Fusion was observed in 17 (77.3%) of the patients, whereas the remaining 5 patients (22.7%) had asymptomatic pseudarthrosis. Of the 66 total cages implanted, subsidence was present in 31 (46.9%). The mean follow-up was 26.1 months. Conclusions: The use of interbody cages Without plate fixation for 3-level anterior cervical discectomy increases cervical lordosis, increases foraminal height, assists fusion, and is associated with good clinical outcomes.Item Clinical importance of ligamentous and osseous structures in the cervical uncovertebral foraminal region(Wiley, 2003-09) Uz, Aysun; Tekdemir, İbrahim; Yılmazlar, Selçuk; Kocaeli, Hasan; Uludağ Üniversitesi/Tıp Fakültesi/Beyin ve Sinir Cerrahisi Anabilim Dalı.; 0000-0003-3633-7919; AAH-5070-2021; 6603059483; 6603500567The vertebral artery, cervical spinal nerves, spinal nerve roots, and the bony and ligamentous tissue related to the cervical vertebrae are structures whose anatomy determines the path of a surgical approach. Defining the anatomy and, in particular, determining the precise location of vulnerable structures at the intervertebral foramen and the uncovertebral foraminal region (UVFR), a region defined by the uncinate process anteriorly, the facet joint posteriorly and the foramen transversarium laterally, has critical significance when selecting the safest surgical approach. We studied the anatomy of the vertebral artery, cervical spinal nerves, and spinal nerve roots within the UVFR in six cadaver specimens. We also obtained measurements of bony structures in 35 dry cervical vertebral columns, from C3-C7. The uncinate process (UP) projects superiorly from the posterolateral aspect of each cervical vertebral body, except for the first and second vertebrae. Because the posterior part of the UP lies adjacent to the vertebral artery, spinal nerve, and spinal nerve roots, its resection creates sufficient space to decompress these structures directly. The posterolateral surface of the UP is covered by ligamentous tissue that originates from the posterior longitudinal ligament and protects the neural and vascular structures during their decompression in the UVFR.Item Clinical importance of the basal cavernous sinuses and cavernous carotid arteries relative to the pituitary gland and macroadenomas: Quantitative analysis of the complete anatomy(Elsevier Science, 2008-08) Yılmazlar, Selçuk; Kocaeli, Hasan; Eyigör, Özhan; Hakyemez, Bahattin; Korfali, Ender; Uludağ ÜniversitesiNöroşirürji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Histoloji ve Embriyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Nöroradyoloji Anabilim Dalı.; 0000-0002-3425-0740; 0000-0003-3633-7919; 0000-0003-3463-7483; AAI-2318-2021; AAH-5070-2021; ABE-5128-2020; 6603059483; 6603500567; 6603109907; 6602527239; 7004641343Background: It is unusual to encounter hemorrhagic complications caused by arterial or venous damage during TSS. Problems with these structures can lead to permanent disability or death. Our aim was to quantitatively analyze anatomical and radiologic relationships among the BCS, the CCA, and the pituitary gland, as these structures are accessed during TSS. Methods: Forty-nine formaldehyde-fixed, sellar-parasellar tissue blocks from adult cadavers were used to simulate accessing the BCSs via TSS. In each specimen, size of the pituitary gland and specific characteristics of each BCS and the horizontal segment of each CCA were recorded. Nine other specimens were used for histologic investigation and microanatomical measurements. To attest correlation between clinical data and cadaveric measurements, coronal MRI scans of 22 healthy adults as well as of 28 patients with macroadenomas were analyzed. Results: In cadaveric specimens, distances between both CCAs in the BCS were 17.1 +/- 4.0 mm anteriorly, 20.3 +/- 4.2 mm medially, and 18.8 +/- 4.6 mm posteriorly. In this study, the anterior medial space of the BCS was dominant in 12 specimens on the right side and in 5 specimens on the left; the posterior medial space of the BCS was dominant in 23 specimens on the right side and in 9 specimens on the left side. The right medial BCS was dominant in 35 specimens. On histologic coronal sections, some part of the carotid artery's (CA's) diameter was located below the line passing from the basal dural layer ranging from 5.3% to 65.4%. In normal-sella images, distances between both CCAs were 15.4 +/- 1.8 mm anteriorly, 16.0 +/- 2.8 mm medially, 16.2 +/- 3.4 mm posteriorly. On coronal normal-sella images, some part of the CA's diameter was located below the line passing from the basal dural layer ranging from 16.4% to 66.7%. In macroadenomas, distances between both CCAs were 22.0 +/- 3.6 mm anteriorly, 21.5 +/- 3.8 mm medially, and 20.7.2 +/- 3.7 mm posteriorly. On coronal images, in only 6 of 28 macroadenomas, some part of the CA's diameter was located below the line passing from the basal dural layer ranging from 12.5% to 100%. Conclusions: Our results indicate that a working area of 15.0 +/- 2.6 x 10.3 +/- 2.1 mm is safe during TSS. The position of the CCA posterior segment was notably more caudal than the anterior segment with respect to the basal dura, which should be taken into account during extended exposure. Also, preoperative recognition of the anatomical variations is beneficial for detection of the boundaries of dissection, which is particularly important in the BCS, where variable course of CCAs may transform the anatomical configuration. Slowly growing pituitary adenomas stretch out both CCAs considerably from medial to lateral directions, and they cause widening of intercarotid distances in all segments. Processing of fixation, decalcification, and paraffin embedding for the cadaveric tissue in contrast to physiologically hydrated tissues may change the accuracy of measurements. These measurements are significantly different than those in the radiologic images when arterial blood under pressure is in the CCA as well as when venous blood fills the cavernous sinus as is the case in vivo. In clinical practice, these facts must be taken into consideration in the cadaveric measurements.Publication Co-loading of Temozolomide with Oleuropein or rutin into polylactic acid core-shell nanofiber webs inhibit glioblastoma cell by controlled release(Elsevier, 2023-09-03) Erçelik, Melis; Tekin, Çağla; Parin, Fatma Nur; Mutlu, Büşra; Doğan, Hazal Yılmaz; Tezcan, Gülçin; Aksoy, Seçil Ak; Gürbüz, Melisa; Yıldırım, Kenan; Bekar, Ahmet; Kocaeli, Hasan; Taşkapılıoğlu, Mevlüt Özgür; Eser, Pınar; Tunca, Berrin; Erçelik, Melis; Tekin, Çağla; TEZCAN, GÜLÇİN; Aksoy, Seçil Ak; Gürbüz, Melisa; BEKAR, AHMET; KOCAELİ, HASAN; TAŞKAPILIOĞLU, MEVLÜT ÖZGÜR; Eser, Pınar; TUNCA, BERRİN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Biyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Diş Hekimliği Fakültesi/Temel Bilimler Bölümü.; Bursa Uludağ Üniversitesi/İnegöl Meslek Yüksekokulu.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Deney Hayvanları Yetiştirme ve Araştırma Birimi.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Beyin Cerrahi Anabilim Dalı.; 0000-0002-1640-6035; 0000-0003-0132-9927; 0000-0002-1619-6680; ABX-9081-2022; AAI-2073-2021; HKM-7750-2023; EUG-3329-2022; GDC-6329-2022; JJL-1176-2023; JJH-2235-2023; CGB-7869-2022; FDK-3229-2022; IRO-2619-2023Glioblastoma (GB) has susceptibility to post-surgical recurrence. Therefore, local treatment methods are required against recurrent GB cells in the post-surgical area. In this study, we developed a nanofiber-based local therapy against GB cells using Oleuropein (OL), and rutin and their combinations with Temozolomide (TMZ). The polylactic acid (PLA) coreshell nanofiber webs were encapsulated with OL (PLA(OL)), rutin (PLA(rutin)), and TMZ (PLA(TMZ)) by an electrospinning process. A SEM visualized the morphology and the total immersion method determined the release characteristics of PLA webs. Real-time cell tracking analysis for cell growth, dual Acridine Orange/Propidium Iodide staining for cell viability, a scratch wound healing assay for migration capacity, and a sphere formation assay for tumor spheroid aggressiveness were used. All polymeric nanofiber webs had core -shell structures with an average diameter between 133 +/- 30.7-139 +/- 20.5 nm. All PLA webs promoted apoptotic cell death, suppressed cell migration, and spheres growth (p < 0.0001). PLA(OL) and PLA(TMZ) suppressed GB cell viability with a controlled release that increased over 120 h, while PLA(rutin) caused rapid cell inhibition (p < 0.0001). Collectively, our findings suggest that core-shell nanowebs could be a novel and effective therapeutic tool for the controlled release of OL and TMZ against recurrent GB cells.Publication Coexistence of TERT C228T mutation and MALAT1 dysregulation in primary glioblastoma: new prognostic and therapeutic targets(Taylor & Francis, 2021-06-21) Ak Aksoy, Seçil; Mutlu, Melis; Tunca, Berrin; Kocaeli, Hasan; Taşkapılıoğlu, Mevlüt Özgür; Bekar, Ahmet; Tekin, Çağla; Arğadal, Ömer Gökay; Civan, Muhammet Nafi; Kaya, İsmail Seçkin; Ocak, Pınar Eser; Tolunay, Şahsine; AKSOY, SEÇİL; Mutlu, Melis; TUNCA, BERRİN; KOCAELİ, HASAN; TAŞKAPILIOĞLU, MEVLÜT ÖZGÜR; BEKAR, AHMET; Tekin, Çağla; ARGADAL, ÖMER GÖKAY; Civan, Muhammet Nafi; KAYA, İSMAİL SEÇKİN; OCAK, PINAR; TOLUNAY, ŞAHSİNE; Bursa Uludağ Üniversitesi/İnegöl Meslek Yüksekokulu.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Biyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Beyin Cerrahi Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Patoloji Anabilim Dalı.; 0000-0002-1619-6680; 0000-0001-5472-9065; 0000-0003-0132-9927; 0000-0002-5126-1548; ADM-8457-2022; ABX-9081-2022; AAI-2073-2021; FPB-0403-2022; ABI-6078-2020; FDK-3229-2022; AAW-5254-2020; GDC-6329-2022; CCA-2925-2022; HKP-0793-2023; ILC-4543-2023; AAI-1612-2021Objective: This study was designed to conduct molecular classification based on IDH1/2, TERT, ATRX, and DAXX changes in pediatric and adult primary glioblastoma (GB) and to analyze the potential interaction of LncRNA MALAT1 in the determined homogeneous subgroups. Methods: We analyzed the expression profiles of ATRX/DAXX and MALAT1 using the qRT-PCR method and IDH and TERT mutation status using DNA sequencing analysis in 85 primary pediatric and adult GB patients. Results: IDH1 mutation was observed in 5 (5.88%) and TERT mutation in 65 (76.47%) primary pediatric and adult GB patients. ATRX and DAXX were detected in 18 (21.18%) and 7 (8.24%) patients. TERT mutation and loss of ATRX/DAXX were associated with short overall survival (p < 0.001, p < 0.001, respectively). Patients carrying especially TERT C228T mutation had worse prognosis (p < 0.001). Six subgroups were obtained from the genetic analysis. Among the subgroups, MALAT1 was highly expressed in group A that had a single TERT mutation as compared to that in groups D and E (p = 0.001 and p < 0.001, respectively); further, high MALAT1 expression was associated with worse prognosis in patients with C228T mutation (p < 0.001). Conclusions: Our findings highlight that the presence of TERT C228T mutation and expression of MALAT1 can be used as primary targets during the follow-up of primary GB patients and in the development of new treatment strategies.Publication Comparison of clinical and molecular wnt and shh subgroups in medulloblastoma tumor cases(Turkish Neurosurgical Soc, 2021-01-01) Kaya, Ismail Seckin; Aksoy, Secil; Mutlu, Melis; Tekin, Cagla; Taskapilioglu, Mevlut Ozgur; Tunca, Berrin; Civan, Muhammet Nafi; Ocak, Pinar Eser; Kocaeli, Hasan; Bekar, Ahmet; Egeli, Unal; Cecener, Gulsah; Tolunay, Sahsine; Kaya, Ismail Seckin; KAYA, İSMAİL SEÇKİN; Aksoy, Secil; AKSOY, SEÇİL; Mutlu, Melis; Tekin, Cagla; Taskapilioglu, Mevlut Ozgur; TAŞKAPILIOĞLU, MEVLÜT ÖZGÜR; Tunca, Berrin; TUNCA, BERRİN; Civan, Muhammet Nafi; Ocak, Pinar Eser; Kocaeli, Hasan; KOCAELİ, HASAN; Bekar, Ahmet; BEKAR, AHMET; Egeli, Unal; EGELİ, ÜNAL; Cecener, Gulsah; ÇEÇENER, GÜLŞAH; Tolunay, Sahsine; TOLUNAY, ŞAHSİNE; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Beyin Cerrahi Bölümü.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Medikal Biyoloji Bölümü.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Pataloji Anabilim Dalı.; 0000-0001-5472-9065; 0000-0002-1619-6680; 0000-0003-0132-9927; 0000-0001-7904-883X; 0000-0002-3820-424X; AAH-1420-2021; AAH-8540-2021; ABX-9081-2022; HKP-0793-2023; AAI-2073-2021AIM: To determine the Wnt and SHH subtypes at the molecular level, and to compare them clinically by examining the changes in CTNNB1, AXIN, PTCH1, SMO, SUFU, and GLI1 mRNA expression in the medulloblastoma of a Turkish population determined according to patient selection criteria. In this context, the clinical distinction between Wnt and SHH groups are realized by considering the age, gender, survival time, location of the lesion, and radiological features of the patients.MATERIAL and METHODS: Molecular separation was performed by RT-PCR analysis of CTNNB1, AXIN, PTCH1, SMO, SUFU, and GLI1 mRNA expression changes.RESULTS: About 17.8% and 22.2% of the cases were included in the Wnt and the SHH group, respectively. When comparing group differences based on clinical and molecular data, 72.7% and 66.6% of matches were observed in the Wnt and the SHH group, respectively.CONCLUSION: It has been revealed that molecular analysis and grouping of patients with medulloblastoma can provide support for clinically determined subgroups.Item Dermal sinus traktusu ile ilişkili enfekte serebellar dermoid kist: olgu sunumu(Uludağ Üniversitesi, 2003-02-04) Yılmazlar, Selçuk; Taşkapılıoğlu, Özgür; Kocaeli, Hasan; Doğan, Şeref; Aksoy, Kaya; Uludağ Üniversitesi/Tıp Fakültesi/Nöroşirürji Anabilim Dalı.Giriş: Dermal sinus traktusları deri ve derin dokular arasındaki anormal bağlantılardır. Konjenital kranial dermal sinuslar yüzeysel dermal tabaka ile derin kranial yapılar arasında uzanan çok katlı yassı epitel ile döşeli orta hat traktuslarıdır. Traktus seyri boyunca herhangi bir yerde dermoidleri veya daha az olarak epidermoidleri oluşturacak şekilde genişleyebilir veya bu kistik yapılar ile sonlanabilir. Kranium içinde çoğunluğu oksipital bölgede lokalizedir. Dermal sinus traktusuna bağlı serebellar abse nadir bir olaydır. Benign konjenital lezyonlar olmalarına rağmen, özellikle bakteriyel veya aseptik menenjitler ve serebellar abseler gibi yüksek sıklıkta komplikasyonları vardır. Klinik sunum: Tekrarlayan menenjitler ile kendini gösteren, enfekte dermoid kist ve serebellar abse ile birlikte olan, oksipital dermal sinus traktusuna sahip altı yaşında hasta sunulmuştur. Dermal sinus traktusu serebelluma doğru takip edilerek, enfekte dermoid kist ve abse kesesi tamamı ile çıkartıldı. Sonuç: Dermal sinus traktusları tekrarlayan menenjitler, abse gelişimi ve kafaiçi basınç artışı ve hidrosefali gibi non-spesifik klinik tablolara sahiptir. Manyetik rezonans görüntülemeye ilave olarak kemik pencere bilgisayarlı tomografi incelemesinde kemik defektinin saptanması patoloji için tanı koydurucudur. Manyetik rezonans görüntüleme ile yumuşak doku ve traktusun kendisi gösterilebilir, birlikte olan dermoid kist görüntülenebilir. BT incelemesi (kemik pencerede) kemiği kateden traktusu gösterebilir. Manyetik rezonans görüntülemeden ve BT çalışmalarından elde edilen en önemli bilgi dermal sinus traktusunun, bilhassa intrakranial uzanımı veya bir intrakranial kist ile sonlanmasının olup olmadığını ortaya koymaktır. Cerrahi olarak intrakranial-ekstrakranial kısımları ve sinus traktusunu tamamı ile çıkarmak rekürrensin önlenmesinde önemlidir.Item Details of fibroligamentous structures in the cervical unco-vertebral region: An obscure corner(Springer France, 2003-04) Tekdemir, İbrahim; Yılmazlar, Selçuk; İkiz, İhsaniye; Kocaeli, Hasan; Adım, Şaduman Balaban; Uludağ Üniversitesi/Tıp Fakültesi/Beyin ve Sinir Cerrahisi Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Anatomi Anabilim Dalı.; 0000-0003-3633-7919; AAH-5070-2021; 6603059483; 6508018224; 6603500567; 7004323599; 15730076300Vertebral bone, joints and ligaments on the cervical spine are structures that maintain the stability of the spine and protect the neurovascular structures. Determining the detailed anatomical location of the intervertebral foramen and unco-vertebral (UV) region with respect to the vertebral bone, joint and ligaments is critical when choosing the safest surgical approach to the cervical spine. We studied the microscopic detailed anatomy of the dural covering and posterior longitudinal ligament (PLL) in eight cadaver specimens and the relevance of these structures in the UV region from C4 to C7. The uncinate process (UP) and its covering ligaments are mechanical barriers that prevent the nerve root and the vertebral artery against unintentional surgical damage. Dissection at the posterolateral surface of the UP revealed a separate perivascular fibroligamentous tissue (PVFLT) that originates from the PLL. The recognition of the PVFLT may provide for safe surgery by protecting the neural and vascular structures during decompression in the UV region.