Person: YILMAZLAR, SELÇUK
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YILMAZLAR
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SELÇUK
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Publication A neurosurgical assessment of the blood supply in the optochiasmatic system: A cadaveric-anatomic study(Springer, 2021-01-05) Baykal, Duygu; Yılmazlar, Selçuk; Fedakar, Recep; Baykal, Duygu; YILMAZLAR, SELÇUK; FEDAKAR, RECEP; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Beyin Cerrahisi Anabilim Dalı; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Adli Tıp Anabilim Dalı; 0000-0003-3633-7919; AAH-5070-2021; AAH-6287-2021; GMD-4113-2022The chiasmal and subchiasmal surfaces are of critical importance in connection with the performance of surgical procedures owing to the critical blood supply to these areas. Recently, the perforating arteries providing the blood to the optic nerves and chiasm have gained attention as they significantly affect the morbidity from surgical approaches. Intraoperative preservation of these perforating arteries is considered critical to prevent further visual loss. Thirty autopsy specimens, including the optic apparatus, were examined for their perforating arteries feeding the optic chiasm and optic nerves. The optic nerves and chiasmal surfaces were divided into four zones based on the presence and numbers of perforating arteries as anterior superior-posterior superior surfaces and anterior inferior-posterior inferior surfaces. The superior surface of the optic chiasm was supplied by the A1 segments of the bilateral anterior cerebral arteries and by the perforating arteries originating from the anterior communicating artery. On the other hand, the inferior surface of the optic chiasm was fed by the bilateral posterior communicating arteries and by the supraclinoidal segments of the bilateral carotid arteries. We demonstrated the anatomical involvement of a large number of nourishing arteries in feeding the optic apparatus related to the perforating arteries by classifying them into zones based on the surgical approaches, which has been rarely reported in the literature.Publication Statistical shape analysis of cerebellum in patients with chiari malformation I(Lippincott, 2019-09-01) Ocakoğlu, Gökhan; Baykal, Duygu; Altunyuva, Oğuz; Taşkapılıoğlu, Mevlüt Özgür; Yılmazlar, Selçuk; OCAKOĞLU, GÖKHAN; ALTUNYUVA, OĞUZ; TAŞKAPILIOĞLU, MEVLÜT ÖZGÜR; YILMAZLAR, SELÇUK; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Beyin Cerrahi Anabilim Dalı; 0000-0003-3633-7919; 0000-0002-3450-0471; 0000-0001-5472-9065; ABB-8161-2020; AAW-5254-2020; HLG-6346-2023; AAH-5180-2021; AAK-9899-2020; AAH-5070-2021The surgical procedure is viewed as a typical treatment choice for patients with Chiari malformation (CM). Decompression is the preferred method for surgery, but it is not always possible to understand whether decompression has been successful especially in an early period. The present study focuses on investigating the shape differences in the cerebellums of Chiari patients compared with healthy controls, and to assess the clinical application of this situation whether if present. The MRI scans were reviewed retrospectively. Cerebellar data were obtained from the digital images and 9 anthropometric landmarks were marked on each image. Shape difference was assessed by performing Generalized Procrustes analysis. The cerebellar shape deformation from control to the patient was evaluated performing the Thin Plate Spline approach. There is a statistically significant cerebellar shape difference between groups. Highest deformation was determined at the cerebellar tonsillar inferior area, posterior of the uvula, and anterior of inferior medullary velum. The present study demonstrated cerebellar shape differences in CM I patients using a landmark-based geometric morphometric approach, considering the topographic distribution of cerebellum for the first time.Publication The anatomic variations and surgical windows among optic chiasm/nerves and carotid arteries in the sellar region play a role in choosing the best surgical approaches: A Cadaveric study(Elsevier Espana, 2020-05-01) Baykal, Duygu; Yılmazlar, Selçuk; Fedakar, Recep; Baykal, Duygu; YILMAZLAR, SELÇUK; FEDAKAR, RECEP; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Beyin Cerrahi Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Adli Tıp Anabilim Dalı.; 0000-0001-9833-9392; 0000-0003-3633-7919; AAH-5070-2021; AAH-6287-2021; GMD-4113-2022Objective: Understanding the relationship between the carotid artery, optic nerve and the anterior clinoid process is the basis of surgical approaches performed in the subchiasmal region. The location of the optic chiasm, the length of the optic nerves, and the distance and angle between the optic nerves determine the route of surgical approaches. We have determined the types of optic chiasm to study the relationship between vascular and neural structures in this region.Materials and methods: Thirty autopsy specimens were investigated at the Bursa Forensic Medicine Institute for optic chiasm types and the relationship between the neural and vascular anatomical structures of the sellar-parasellar and subchiasmal region was examined between June 2016 and November 2016.Results: In this study, 4 prefix types (13%), 6 postfix types (20%), and 20 central types (67%) of chiasm were defined. Furthermore, we measured this angle between two optic nerves, which indirectly shows the location of chiasm according to the diaphragma sellae, and then detected the mean value of this angle as 87.1 +/- 11.6 degrees. The "limit" value to designate a chiasm as prefix was measured in the current study as >= 101.1 degrees. T.he angle between optic nerves ranged from a mean value of 69.9 +/- 3.7 degrees in 6 cases with postfix chiasm, to a mean value of 104.0 +/- 2.1 degrees in 4 cases with prefix chiasm and a mean value of 88.8 +/- 6.7 degrees in 20 cases with central chiasm.Conclusion: In this study, we showed that the relationship among optic chiasma types, optic nerves and bony and vascular structures around the sellar area was effective at determining the surgical approach to this region. (C) 2019 Sociedad Espanola de Neurocirugia. Published by Elsevier Espana, S.L.U. All rights reserved.Publication Statistical shape analyses of the brainstem in chiari patients(Türk Nöroloji Derneği, 2021-01-01) Ocakoglu, Gokhan; OCAKOĞLU, GÖKHAN; Taskapilioglu, Mevlut Ozgur; TAŞKAPILIOĞLU, MEVLÜT ÖZGÜR; Altunyuva, Oguz; ALTUNYUVA, OĞUZ; Yilmazlar, Selcuk; YILMAZLAR, SELÇUK; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Biyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Nöroşirürji Anabilim Dalı.; 0000-0002-1114-6051; 0000-0001-5472-9065; 0000-0002-3450-0471; AAH-5180-2021; AAK-9899-2020AIM: To ascertain whether the brain stem's shape differs in patients with syrinx and without syrinx in cases with Chiari malformation Type I (CM-1), relative to healthy controls.MATERIAL and METHODS: Data on marked brainstem regions were obtained from 2D digital image files. Generalized Procrustes analysis was used to evaluate shape differences among patients with syrinx, patients without syrinx, and healthy controls. Shape deformations among groups were examined by Thin Plate Spline (TPS) analysis.RESULTS: According to the brain stem shape, there were differences between patients with syrinx and controls, and between patients without syrinx and controls. High-level deformations were also observed among the groups.CONCLUSION: In the present study, the presence of shape deformations in Chiari patients' brainstem was demonstrated. This is the first study using a landmark-based geometrical morphometric method to demonstrate the shape difference in Chiari patients' brainstem.Publication Comparison of the effects of medical and surgical treatments in giant prolactinoma: A single-center experience(Springer, 2021-07-08) Hakyemez, Bahattin; Cander, Soner; CANDER, SONER; Oz Gul, Ozen; ÖZ GÜL, ÖZEN; Eylemer, Eda; Gunes, Elif; Hakyemez, Bahattin; HAKYEMEZ, BAHATTİN; Gullulu Boz, Elif; GÜLLÜLÜ BOZ, SAİDE ELİF; Yilmazlar, Selcuk; YILMAZLAR, SELÇUK; Ersoy, Canan; ERSOY, CANAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi.; AAA-3274-2019Purpose Giant prolactinomas, which have extremely large sizes and high prolactin (PRL) values, are rarely seen. Although medical therapy is effective, surgical treatment is more frequently applied due to slightly lower response rates and compression symptoms. This study aimed to compare the medical and surgical treatment results in giant prolactinomas. Methods Thirty-nine patients who were followed up in our center for giant prolactinoma were included in the study, and the response rates of the patients were evaluated after the medical and surgical treatments. The treatment responses were compared in terms of tumor volume, PRL level, visual field, and pituitary function. Results The outcomes of the 66 treatment periods (medical n = 42; surgical n = 24) in 39 patients (mean age, 47.2 years; men, 89.7%) were evaluated. The most common presentations were hypogonadism and visual defects. The mean longest tumor diameter at diagnosis was 52.2 +/- 11.8 mm, and the median PRL levels were 5000 ng/mL. PRL level normalization was achieved in 69% with medical therapy, and a curative response was obtained in only two patients with surgery. Tumor volume reduction was 67% (no cure) in the medical and 75% (13% cure) in the surgical groups (p = 0.39). Improvement of visual field was 70.8% in the medical and 84.2% in the surgical group (p = 0.12). Conclusion In our study, it was observed that medical therapy was effective and safe in patients with giant prolactinomas. The use of surgical treatment should be limited to prolactinomas with compression or post-resistance to medical treatment in serious cases.Publication Demonstration of cephaloceles in patients with rhinorrhea: Single centre experience of intrathecal gadolinium enhanced MR cisternography(Briefland, 2020-01-01) Cebeci, Hakan; Bilgin, Cem; Candan, Selman; Yılmazlar, Selçuk; Hakyemez, Bahattin; BİLGİN, CEM; CANDAN, SELMAN; YILMAZLAR, SELÇUK; HAKYEMEZ, BAHATTİN; Bursa Uludağ Üniversitesi/Tıp Fakültesi.; HHS-7433-2022; AAH-5070-2021; AAI-2318-2021; GVS-7682-2022Background: MR cisternography has the crucial role for diagnosis of cerebrospinal fluid (CSF) leakage in patients with rhinorrhea and otorrhea. Trauma is the major cause of rhinorrhea. Cephalocele is diagnosed in some rhinorrhea patients.Objectives: To evaluate the CSF leakage in patients with rhinorrhea and assess the frequency of cephalocele in the etiology of rhinorrhea.Patients and Methods: Intrathecal gadolinium enhanced MR cisternography and nonenhanced CT of paranasal sinus images of patients with suspected CSF rhinorrhea between October 2012 and September 2018 were evaluated retrospectively. Twenty-one patients with the diagnosis of contrast leakage causing rhinorrhea were included in the study. All patients had intrathecal gadolinium enhanced MR cisternography. Three dimensional (3D)-T1 weighted and 3D-fluid attenuated inversion recovery (FLAIR) head MRI was obtained after administration of 1 ml intrathecal gadoterate meglumine after half, 3, and 8 hours. Locations of contrast leakage and etiologies were analyzed.Results: Patient group consisted of 21 patients with persistent or intermittent rhinorrhea. CT imaging showed bone defect in all patients. Intrathecal gadolinium enhanced MR cisternography revealed CSF leakage (10 ethmoid, 10 sphenoid, and 1 frontal). Cephalocele was detected in 10 of 21 patients.Conclusion: MR cisternography with intrathecal gadolinium enhancement is an effective and safe imaging modality compared to other techniques used for diagnosis of CSF leakage. Accurate localization of CSF fistula and demonstration of herniating content from cranial bone defect is feasible with this technique.Publication Anatomical aspects of optic nerve decompression in transcranial and transsphenoidal approach(Churchill Livingstone, 2019-04-01) Güler, Tuğba Moralı; Yılmazlar, Selçuk; Özgün, Gonca; YILMAZLAR, SELÇUK; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Beyin Cerrahisi Anabilim Dalı; 0000-0003-3633-7919; AAH-5070-2021Purpose: The proximal portion of the optic nerve is quite prone to injury at the entrance of the optic foramen by tumoral or traumatic pathologies. As a result, it is important to show which way and which part we can effectively and safely decompress the pathologies affecting the optic nerves. In this study, we compared the decompression of the proximal segment of the optic canal Likewise, we investigated the anatomy and histopathology of the opticocarotid region from below and above.Materials and methods: A total of 30 adult sellar and parasellar samples were extracted from human cadavers. Anatomical dissection and histological examination were performed from transcranial and transsphenoidal ways. The walls of the proximal optic canal were evaluated with an operating microscope and endoscope. The relationship between the optic canal, the internal carotid artery, and the optic nerve were qualitatively and quantitatively examined.Results: Similar rates of circular optic canal decompression were achieved by each approach; however, by means of decompression, the transsphenoidal approach was superior for the inferior and medial portions of the optic nerve and transcranial approach was superior for the superior and lateral portions and also more appropriate for optic nerve mobilization.Conclusion: This is one of the first studies to reveal the ways of the decompression of the proximal optic canal by transcranial and transsphenoidal approaches. According to this study, the medial and inferior proximal portions of the optic nerves are histologically more prone to injury caused by traction or compression. Transcranial or transsphenoidal approach should be preferred according to the location of the pathology and anatomical and histological characteristics of this region. (C) 2019 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.