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Öğe Anatomic and radiologic analysis of the atlantal part of the vertebral artery(ELSEVIER SCI LTD, 2009) Cengiz, Sahika Liva; Cicekcibas, Aynur; Kiresi, Demet; Kocaogullar, Yalcin; Cicek, Onur; Baysefer, Alper; Buyukmumcu, MustafaThe horizontal third segment (V3h) of the vertebral artery (VA) in 7 cadavers (14 sides) was dissected and the anatomical measurements recorded. Measurements from 24 healthy individuals (48 sides) were taken for comparison using multislice CT scanning. The distance between the medial Lip of the VA V3h and the line passing through the mid point of the posterior tuberculum of the atlas was marked as length A. The distance between the medial tip of the VA V3h and the point penetrating the dura mater was classified as length B. The angle between these lines was the alpha (a) angle. Measurements were taken when the head was in a neutral position, as well as in maximum right and left rotation, extension and flexion. In cadavers, the mean alpha angle (+/- S.D.) was 82.42 +/- 10.34 degrees and 83.21 +/- 10.81 degrees on the right and left side, respectively. On multislice CT scanning, the mean a angle was 81.64 +/- 10.15 degrees on the right and 83.77 +/- 10.65 degrees, on the left. These angles varied with the position of the head. (C) 2008 Elsevier Ltd. All rights reserved.Öğe An anatomic study for a modified technique for bypass of the external carotid artery to the proximal middle cerebral artery(SPRINGER, 2008) Cengiz, Sahika Liva; Ozturk, Kayhan; Cicekcibasi, Aynur Emine; Salbacak, Ahmet; Ustun, Mehmet ErkanWe aimed to evaluate whether bypass of the external carotid artery (ECA) to the middle cerebral artery (MCA) can be established by a short saphenous vein graft in order to increase the anastomosis patency. The method was performed to ten adult cadaver sides. We described a modified technique for bypass of the ECA to the M2 segment of MCA. The diameters of the vessels and graft length were measured by using an electronic micrometer. The mean diameter of the superior, middle, and inferior trunks of the MCA with trifurcation were 1.7 +/- 0.15, 2.2 +/- 0.25, and 2.0 +/- 0.2 mm, respectively, whereas the mean diameter of the superior and inferior trunks of the MCA with bifurcation were 2.1 +/- 0.2 and 2.3 +/- 0.3 mm, respectively. The mean diameter of the ECA was 3.75 +/- 0.4 mm. The mean length of the saphenous vein graft was 71.5 +/- 3.9 mm. The high-flow ECA to proximal MCA bypass using a short venous graft can supply enough blood flow to establish cerebral revascularization with a straighter route.Öğe A case report of firearm bullet settling into the thoracic spinal canal without causing neurological deficit or vertebral bone destruction(SPRINGER, 2007) Kalkan, Erdal; Keskin, Fatih; Cengiz, Sahika Liva; Baysefer, AlperObjective The main objective of this study was to present a case of gunshot injury in which a bullet particle settled into the inferior-thoracic epidural canal, which was neurologically intact, without causing any vertebral bone destruction. Summary and background data There has been no previous report in the literature regarding a foreign body settling into the vertebral canal following gunshot injury without causing any bony destruction. Case report A 40-year-old male patient was hospitalized in emergency service with the complaints of severe pain in his back and both legs secondary to a gunshot wound. The entrance wound of the traversing projectile was located at the level of the tenth costa at the inferior of the right scapula. Neurological examination revealed no motor deficit. His lung X-ray was normal at radiological examination. Direct radiograph determined a bullet nucleus on the medium line at thoracolumbar level T-12. Intracanalicular bullet nucleus was found at posterior epidural at the T-12 level on thoracic CT, myelography and CT myelography. No vertebral bone destruction was seen in the direct radiograph studies and serial CT. T12 total laminectomy was performed and epidural foreign body removed. The patient, whose pains ameliorated during the postoperative process, was discharged without any neurological deficit. Conclusion We prefer removal of firearm particles settling into the spinal canal in view of possible later complications such as infection and the toxic effect of the metallic particles, unless there appears any risk of neurological detriment to the patient.Öğe The effect of meperidine-impregnated autogenous free fat grafts on postoperative pain management in lumbar disc surgery(LIPPINCOTT WILLIAMS & WILKINS, 2008) Kalkan, Erdal; Torun, Fuat; Tavlan, Aybars; Cengiz, Sahika Liva; Kaya, BuelentStudy Design: Prospective, randomized, double-blind clinical study. Objective: To examine the effect of meperidine-impregnated autogenous free fat grafts (AFFGs) on postoperative pain management after 1-level, first-time lumbar disc surgery. Summary of Background Data: Uncontrolled postoperative pain impedes patient recovery. Insuffidient control of postoperative pain makes it difficult to convince new patients to undergo the lumbar disc surgery. Methods: Twenty-seven patients scheduled to undergo lumbar microdiscectomy for the first time were divided into 2 groups by a randomized double-blind method. Group 1 patients received a meperidine-impregnated AFFG in the epidural area. Group 2 received the graft without meperidine impregnation. Both groups were asked to use a Patient Controlled Analgesia device to deliver tramadol, and at 1, 4, 12, and 24 hours postoperatively, the amounts of tramadol used and pain severity on the 10-cm Visual Analog Scale (VAS) were recorded. Results: The VAS scores and total tramadol use were both lower in group 1 compared with the control group (P < 0.05). The first hour of VAS scores were significantly lower in group 1 than in the control group (P < 0.05). Conclusions: In this study, we helped patients, who underwent I-level, first-time lumbar microdiscectomy have a postoperative pain-free and comfortable period by using epidural meperidine-impregnated AFFGs.Öğe The effects of mannitol and melatonin on MRI findings in an animal model of traumatic brain edema(SPRINGER HEIDELBERG, 2008) Bayir, Ayseguel; Kiresi, Demet Aydogdu; Kara, Hasan; Cengiz, Sahika Liva; Kocak, Sedat; Oezdinc, Serife; Ak, AhmetObjectives: The aim of this study was to compare the effects of mannitol and melatonin on brain edema secondary to trauma using magnetic resonance imaging (MRI). Methods : A mild traumatic brain injury with the Feeney method was performed upon twelve New Zealand rabbits. Three hours after the trauma was inflicted, MRI images were obtained, then the subjects were divided into two groups : a mannitol group and a melatonin group. The mannitol group (n = 6) was given 2 gr/kg of 20% mannitol IV over 10 minutes and the melatonin group (n = 6) received 100 mg/kg of melatonin IV over 30 minutes. Thirty-three hours after the first MRI, MRI was repeated. The 3-hour and 36-hour post-trauma MRI images in both groups were scored regarding signs of edema and extent of brain tissue protrusion in a blinded fashion by a staff radiologist. Intragroup and intergroup comparisons were made using the Fisher exact test and chi square test. Comparison of brain tissue protrusion measurements was done using the Mann Whitney U test. Results : Signs of raised intraventricular pressure, contusion and parenchymal edema were more prevelant, and parenchymal protrusion was more prominent on the 36-hour MRI in both mannitol and melatonin groups. No significant difference was,found between the melatonin and mannitol groups in any parameter in the MRI images performed 3 and 36 hours after the head trauma. Conclusions : In this animal model, melatonin and mannitol had similar effects on brain edema, as demonstrated on MRI 3 and 36 hours after head trauma.Öğe The efficacy of intrathecal administration of a very low dose potirelin after acute spinal cord injury(ELSEVIER SCI LTD, 2008) Cengiz, Sahika Liva; Ustun, Mehmet Erkan; Topcu, Cemile; Ahmet, A. K.Background and object: The objective of this study was to determine the effect of a very tow dose protirelin in cerebrospinal fluid (CSF) glucose, magnesium and lactate levels after spinal cord trauma (SCT) in rabbits. We also aimed to evaluate whether this very tow dose might induce analeptic effect. Material and methods: Twenty rabbits were divided equally into two groups: group I (n = 10) was the control group, suffered from SCT but received only saline after SCT. Group II (n = 10) (treatment group), received a very low dose of 0.05 mg/kg thyrotropin releasing hormone (TRH), analogue protirelin intrathecally after SCT. The basal CSF glucose, magnesium and lactate levels were recorded in both groups. CSF lactate, glucose and magnesium contents were recorded at the same time (an hour before and after) SCT Serum thyroid stimulating hormone (TSH), freetriiodothyronine (73) and freethyroxine (FT4) were measured in all rabbits before and after SCT. Results: Before spinal cord trauma, there were not any significant differences in glucose, lactate and magnesium Levels between group I and II whereas, after spinal cord trauma in group 11, the significant suppression in elevation of Lactate and glucose depletion (p < 0.05) were observed white no significant suppression was observed in magnesium level (p > 0.05) as compared with group I (Table 3). In respect of serum TSH levels, there were not any significant differences between two groups before and after SCT. Conclusions: This study showed that intrathecal TRH has no analeptic effect on serum TSH, FT3 and FT4 levels but can attenuate the increase of lactate levels following spinal cord trauma. No significant decrease in magnesium level and also suppression of glucose decline in group II, may be related to the neuroprotective effects of TRH. (C) 2008 Published by Elsevier Ltd.Öğe The morphometric analysis of the V2 and V3 segments of the vertebral artery: Normal values on MDCT(PERGAMON-ELSEVIER SCIENCE LTD, 2009) Kiresi, Demet; Gumus, Serter; Cengiz, Sahika Liva; Cicekdbasi, AynurA potential hazard in midline posterior fossa craniectomy may be the injury of vertebral artery. That's why vertebral artery evaluation prior to surgery may prevent dangerous complications. Advancements in multidetector computed tomography (MDCT) have provided detailed demonstration of the vertebral artery at the craniocervical junction and its relationships with atlas and axis. We aimed to define the normal anatomic relationship of the V2 and V3 part of the vertebral artery on MDCT. In total, 33 patients underwent MDCT angiography scan with suspected cranial aneurysm. V2 and V3 segments of vertebral artery were evaluated. Eight measurements (B, C, D, E, G, H, X, and Y line) were taken from MDCT images. For B and C, a line initially passing through the body of axis and spinous process and determining the midline was formed. Then, the vertical distance of vertebral artery from the level of transverse foramen of axis and loop to this midline was measured. For D and G, the vertical distance of vertebral artery to the midline from the upper and lower margin levels of transverse foramen of atlas was measured after a line establishing the midline passing through the anterior and posterior tubercles of atlas was drawn first. For E, transverse diameter of vertebral artery was measured at the loop level of V2 segment. For H, the vertical distance at the point where vertebral artery entered dura in the line passing from the midline of foramen magnum at anterior-posterior plane was measured. For X and Y, two different points of horizontal part of the vertebral artery were determined. One of these two points was the lateral one which was the origin of the horizontal part in the transverse foramen, the other was the intersection point on atlas. Average distances for both sides from transverse foramen of the axis, the loop of axoatlantal part and the lower border of the atlas of the vertebral artery to the midline were 20.97 mm on the right, 22.29 mm on the left; 27.19 mm on the right, 28.34 mm on the left; and 25.75 mm on the right and 27.21 mm on the left, respectively. Average distances for both sides from the upper border of the atlas, and at its penetration through dura were 27.40 mm on the right, 28.94 mm on the left; and 10.90 mm on the right and 10.93 mm on the left, respectively. Distances between spinous process and intersection of vertebral artery with horizontal part were 35.79 mm on the right and 36.63 mm on the left laterally, and 22.27 mm on the right and 22.62 mm on the left medially. MDCT angiography is a powerful test to demonstrate the vasculature of the head and neck. Bony structures and adjacent vessel morphology can be evaluated by this technique. The evaluation of craniocervical region prior to surgery with MDCT may be helpful to avoid intraoperative vascular injuries. (C) 2009 Elsevier Ltd. All rights reserved.Öğe Proximal STA to proximal PCA bypass using a radial artery graft by posterior oblique transzygomatic subtemporal approach(SPRINGER, 2009) Ulku, Cagatay Han; Cicekcibasi, Aynur Emine; Cengiz, Sahika Liva; Ustun, Mehmet Erkan; Buyukmumcu, MustafaThe aim of the present study was to investigate the use of a radial artery graft (RAG) for bypass of the proximal superficial temporal artery (STA) to proximal posterior cerebral artery (PCA) by posterior oblique transzygomatic subtemporal approach as an alternative to the external carotid artery (ECA) to PCA anastomosis. We conducted an anatomical and technical study at a university hospital. Five adult cadaveric specimens were dissected. A preauricular vertical skin incision was used. The trunk of STA was identified. A 30 degrees oblique posterior zygomatic arch osteotomy and microcraniotomy was performed. The dura of the middle cranial fossa was then opened. The temporal lobe was retracted, the interpeduncular and ambient cisterns were opened, and the P2 segment of the PCA was exposed. The proximal side of the RAG was anastomosed with the proximal STA and the distal side was anastomosed with the P2 segment. The mean caliber of the proximal STA was 2.25 +/- 0.35 mm. The mean diameter of the P-2 was 2.2 +/- 0.2 mm. The average length of the RAG was 56 +/- Ce3.2 mm. The mean caliber of the proximal and the distal sides of the graft was 2.5 +/- 0.25 mm and 2.3 +/- Ce0.15 mm, respectively. Because the proximal STA to proximal PCA bypass uses a short RAG and their calibers are over 2 mm, this bypass technique can provide a sufficient blood flow and may be a reasonable alternative over ECA to PCA bypass using long grafts.Öğe The role of intravenous immunoglobulin in the treatment of cerebral vasospasm induced by subarachnoid haemorrhage: An experimental study(TAYLOR & FRANCIS LTD, 2011) Cengiz, Sahika Liva; Erdi, Mehmet Fatih; Avunduk, Mustafa Cihat; Tosun, Murat; Ustun, Mehmet Erkan; Gokce, Recep; Yosunkaya, AlperObjectives: The aim of this study was to determine whether intravenous immunoglobulin (IVIG) prevents cerebral vasospasm in rabbits with induced subarachnoid haemorrhage (SAH). The effect of IVIG on apoptosis in the endothelial cells of the basilar artery was also evaluated. Methods: Eighteen New Zealand white rabbits were allocated randomly into three groups. SAH was induced by injecting autologous blood into the cisterna magna. Group 1, the control group, was subjected to sham surgery (no induction of SAH). Group 2 had SAH alone and Group 3 had SAH plus IVIG. Three days after treatment, the animals were sacrificed. The basilar artery tissues were analysed histologically and the malondialdehyde levels in the brain stem tissues were evaluated biochemically. Results: Differences in the histopathological luminal areas and full wall thicknesses in the SAH plus IVIG group and the SAH group were statically insignificant (p > 0.005). The malondialdehyde level was also found to be lower in the IVIG group than in the SAH group, although this difference was not significant (p > 0.005). Conclusion: Although the IVIG treatment was revealed to have no vasodilator effect on the SAH-induced spastic basilar artery, it was shown to have a beneficial effect on the apoptosis of endothelial cells, probably via anti-inflammatory mechanisms.Öğe Timing of thoracolomber spine stabilization in trauma patients; impact on neurological outcome and clinical course. A real prospective (rct) randomized controlled study(SPRINGER, 2008) Cengiz, Sahika Liva; Kalkan, Erdal; Bayir, Aysegul; Ilik, Kemal; Basefer, AlperObjective Optimal timing of stabilization for spinal injuries is discussed controversially. The goal of this study is to investigate the neurological recovery and its influencing factors in thoracolumbar spine fractures after surgical decompression and stabilization within 8 h of spinal cord injury versus surgery which is performed between 3 and 15 days. Methods Twenty-seven patients undergoing thoracolumbar stabilization with neurological deficit for an acute thoracolumbar spinal injury at the level of Th8-L2 vertebra at Selcuk University between March 2004 and December 2006 were recorded. Patients with neurological deficity and medically stable for surgery underwent immediate stabilization within 8 h defined as group I (n = 12) and patients underwent operation in 3-15 days after thoracolumbar injury were defined as group II (n = 15). Patients were assessed for neurologic deficit and improvement as defined by the scoring system of American spinal injury association (ASIA). Results In spite of comparable demographic data, patients in group I had a significantly shorter overall hospital and intensive care unit stay and had lesser systemic complications such as pneumonia and also exhibited better neurological improvement than group II (p < 0.05). Conclusion Early surgery may improve neurological recovery and decrease hospitalization time and also additional systemic complications in patients with thoracolomber spinal cord injuries. Thus early stabilization of thoracolumbar spine fractures within 8 h after trauma appears to be favorable.
