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Öğe Accuracy of fluoroscopically-assisted pedicle screw placement: analysis of 1,218 screws in 198 patients(ELSEVIER SCIENCE INC, 2014) Köktekir, Ender; Ceylan, Davut; Tatarlı, Necati; Karabağlı, Hakan; Recber, Fahri; Akdemir, GökhanBACKGROUND CONTEXT: We retrospectively analyzed a total of 1,218 pedicle screws for accuracy, with postoperative computed tomography (CT), in 198 patients who were operated on between March 2004 and September 2012. PURPOSE: To determine the incidence of screw misplacement in patients who received a transpedicular screw fixation, with intraoperative fluoroscopy in the lateral and lateral with anteroposterior (AP) positions. The results are compared between the two groups. STUDY DESIGN: Retrospective comparative study of accuracy of pedicle screw placement in thoracic and lumbar spine. PATIENT SAMPLE: The sample consists of 198 consecutive patients who underwent transpedicular screw fixation. OUTCOME MEASURES: Accuracy of screw placement was evaluated by postoperative CT scan. Misplacement was defined in cases where more than 25% of the screw size was residing outside the pedicle. METHODS: The indications for hardware placement, radiologic studies, patient demographics, and reoperation rates were recorded. Five hundred twenty-eight screws (Group A, n = 81) were inserted into the vertebral body with the assistance of lateral fluoroscopy only, whereas 690 screws (Group B, n = 117) were inserted with the assistance of lateral fluoroscopy, and the final positions of the screws were checked with AP fluoroscopy. RESULTS: A total of 1,218 screws were analyzed, with 962 screws placed at the lumbosacral region and 256 screws at the thoracic region. According to the postoperative CT scan, 27 screws (2.2%) were identified as breaching the pedicle. Nineteen of them (3.6%) were in Group A, whereas 8 (1.16%) were in Group B. The rate of pedicle breaches was significantly different between Group A and B (p5.0052). In Group A, the lateral violation of the pedicle was seen in 10 screws (1.9%), whereas medial violation was seen in 9 screws (1.7%). In Group B, the lateral violation of the pedicle was seen in six screws (0.87%), whereas medial violation was seen in two screws (0.29%). The medial and lateral penetration of screws were significantly different between Groups A and B (p = .05). A pedicle breach occurred in 21 patients, and 15 of them underwent a revision surgery to correct the misplaced screw. Of these patients, 11 (13.6%) were in Group A, and 4 (3.4%) were in Group B (p = .0335). CONCLUSIONS: In this study, we evaluated and clarified the diagnostic value of intraoperative fluoroscopy in both the lateral and AP imaging that have not yet been evaluated in any comparative study. We concluded that the intraoperative use of fluoroscopy, especially in the AP position, significantly decreases the risk of screw misplacement and the results are comparable with other advanced techniques. (C) 2014 Elsevier Inc. All rights reserved.Öğe Calcified intracranial hydatid cyst: Case report(2011) Köktekir, Ender; Erdem, Yavuz; Gökçek, Cevdet; Karatay, Mete; Yılmaz, Ali; Bayar, Mehmet Akif; Sümer, SuaBu çalışmada; 26 yaşında, çiftlik işleri ile uğraşan, asemptomatik intrakraniyal hidatik kisti olan bir olgu sunulmaktadır. Kafa travması nedeni ile yapılan radyolojik incelemelerde kalsifiye intrakraniyal hidatik kist saptanan hasta cerrahi tedavi ile kitlenin tamamen çıkartılması sonrası nörolojik defisiti olmadan taburcu edildi. İntrakraniyal hidatik kistlerin kalsifikasyonu oldukça nadirdir. Bilgisayarlı beyin tomografisi ve kraniyal magnetik rezonans incelemeleri operasyon öncesi tanı için oldukça önemlidir. Radyolojik incelemeler esnasında membran detaşmanının, kist duvarında kalsifikasyonun ve kist içi membranların varlığı hidatik kist varlığına işaret eder. (Turkiye Parazitol Derg 2011; 35: 220-3)Öğe The Cervical Epidural Space Metastasis of Ewing's Sarcoma(2013) Kaptan, Hülagu; Karabağlı, Pınar; Karabağlı, Hakan; Köktekir, Ender; Akdemir, GökhanEwing sarkomu ilk üç dekatda en sık görülen birincil kemik kanserleridir. Kemik ve akciğer metastazları hızlı bir seyir izler. Ewing sarkomunun omurga tutulumu nadir bir klinik durumdur. Lokal ağrı, ele gelen kitle ve nörolojik defisitler Ewing sarkomu tiradını meydana getirir. Omurga Ewing sarkomunun yönetimi ve tedavisinde, cerrahi, radyoterapi ve kemoterapi kombinasyonları yer almaktadır. Omurga Ewing sarkomunun takibinde akut nörolojik kötüleşme dekompresif cerrahiyi öne çıkarır. Bu çalışmada daha önce Ewing sarkomu tanısı almış 32 yaşında erkek bir hastada, medikal onkoloji tarafından izlemdeyken akut nörolojik kötüleşme sonrası üst ekstremite spastik paraparezi ve alt ekstremitede parapleji nedeniyle acil dekompresif cerrahi uygulanması ve sonuçları literatür eşliğinde tartışılmıştır.Öğe The Cervical Epidural Space Metastasis of Ewing's Sarcoma(JOURNAL NEUROLOGICAL SCIENCES, 2013) Kaptan, Hülagu; Karabağlı, Pınar; Karabağlı, Hakan; Köktekir, Ender; Akdemir, GökhanEwing's sarcoma is a primary bone malignancy with the highest incidence in the first to third decades of life. That in both locations follow a rapid course with metastasis to lung and bone. Ewing's sarcoma of the spine is a rare condition that appears with a clinical triad of local pain, neurological deficit and a palpable mass. The definitive management of Ewing's sarcoma of the spine, as in other locations, could include three main modalities: surgery, radiotherapy, and chemotherapy. In the presence of acute neurological decompensation, decompressive surgery via an appropriate approach should be performed. In this study; a 32-year-old male with a sudden progressive severe upper extremity spastic paresis and paraplegy has been presented. We wanted to discuss the preoperative process and treatment modalities.Öğe The cervical epidural space metastasis of Ewing's sarcoma [Ewing's sarkomunun servikal epidural alana metastazi{dotless}](2013) Kaptan, Hülagu; Karabağlı, Pınar; Karabağlı, Hakan; Köktekir, Ender; Akdemir, GökhanEwing's sarcoma is a primary bone malignancy with the highest incidence in the first to third decades of life. That in both locations follow a rapid course with metastasis to lung and bone. Ewing's sarcoma of the spine is a rare condition that appears with a clinical triad of local pain, neurological deficit and a palpable mass. The definitive management of Ewing's sarcoma of the spine, as in other locations, could include three main modalities: surgery, radiotherapy, and chemotherapy. In the presence of acute neurological decompensation, decompressive surgery via an appropriate approach should be performed. In this study; a 32-year-old male with a sudden progressive severe upper extremity spastic paresis and paraplegy has been presented. We wanted to discuss the preoperative process and treatment modalities.Öğe Fluorodeoxyglucose positron emission tomography/computed tomography findings in a patient with cerebellar mutism after operation in posterior fossa(ELSEVIER SINGAPORE PTE LTD, 2017) Gedik, Gonca Kara; Sarı, Oktay; Köktekir, Ender; Akdemir, GökhanCerebellar mutism is a transient period of speechlessness that evolves after posterior fossa surgery in children. Although direct cerebellar and brain stem injury and supratentorial dysfunction have been implicated in the mediation of mutism, the pathophysiological mechanisms involved in the evolution of this kind of mutism remain unclear. Magnetic resonance imaging revealed dentatothalamocortical tract injuries and single photon emission computed tomography showed cerebellar and cerebral hypoperfusion in patients with cerebellar mutism. However, findings with F-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in this group of patients have not been documented previously. In this clinical case, we report a patient who experienced cerebellar mutism after undergoing a posterior fossa surgery. Right cerebellar and left frontal lobe hypometabolism was shown using FDG PET/CT. The FDG metabolism of both the cerebellum and the frontal lobe returned to normal levels after the resolution of the mutism symptoms. (C) 2017 Asian Surgical Association and Taiwan Robotic Surgical Association. Publishing services by Elsevier B.V.Öğe Iliac artery ınjury during lumbar disc hernia surgery(ELSEVIER SCIENCE INC, 2019) Şahinoğlu, Mert; Arun, Oğuzhan; Orhan, Atilla; Nayman, Alaaddin; Çalışır, Akın; Bocu, Yasin; Cebeci, Yasemin; Duman, Ateş; Yılmaz, Hüseyin; Köktekir, Ender; Karabağlı, HakanBACKGROUND: Vascular injury complications during lumbar discectomy are rare but potentially life-threatening. Therefore, an early diagnosis and effective treatment management is required for these complications. CASE DESCRIPTION: A 50-year-old female patient was admitted to our outpatient clinic with severe back and right leg pain. She underwent surgery for right L4-5 extruded disc herniation with general anesthesia. Sudden arterial hemorrhage occurred during discectomy performed with straight disc forceps and was controlled using hemostatic materials, with no significant decrease in blood pressure. However, the patient became hypotensive near the end of the operation. The incision was quickly closed, and she was turned to supine position. Emergency abdominal ultrasound, computed tomography, and computed tomography angiography revealed an injury of the left main iliac artery, which was repaired by endovascular stenting. Laparotomy and Bogota bag were applied because of increased intrabdominal pressure at 3 hours postoperative. In addition, a retroperitoneal catheter was placed into the area of the right retroperitoneal hematoma on the first postoperative day. Tissue plasminogen activator was administered through the catheter. On postoperative day 3, the Bogota bag was removed, and the abdomen was closed. The patient was discharged without neurodeficit on day 27. Her abdominal fascial defect was closed with a synthetic graft after 5 months. CONCLUSIONS: Although lumbar discectomy is one of the most commonly performed neurosurgical procedures, the routine rules of discectomy should not be neglected. Early detection and a multidisciplinary approach can help prevent mortality in the event of vascular injury.Öğe Intracranial Giant Tuberculoma Mimicking Brain Tumor: A Case Report(TURKISH NEUROSURGICAL SOC, 2015) Sümer, Sua; Köktekir, Ender; Demir, Nazlım Aktuğ; Akdemir, GökhanTuberculomas are small tumor-like lumps that can be seen, usually in large numbers, in central nervous system involvement of tuberculosis. Giant tuberculomas that are big enough to cause symptoms of compression are also encountered, though rarely. When they are really large, tuberculomas may result in increased intracranial compression, neurologic deficits, or epileptic attacks. Giant tuberculomas may be confused with brain tumors on cranial magnetic resonance imaging. Cranial magnetic resonance imaging and histopathology examinations are used for diagnosis. Although magnetic resonance imaging is useful for diagnosing tuberculoma, histopathology examination is the gold standard for a final diagnosis. This paper presents a case involving a 66-year-old patient who complained of headache, imbalance and dizziness, and underwent an operation in the neurosurgery clinic with a pre-diagnosis of brain tumor, and was then diagnosed with intracranial giant tuberculoma.Öğe Lung Adenocarcinoma Metastasis to Frontal Sinus Mimicking Pott's Puffy Tumor(LIPPINCOTT WILLIAMS & WILKINS, 2013) Köktekir, Ender; Köktekir, Bengü Ekinci; Reçber, Fahri; Akdemir, GökhanMetastasis of the lung adenocarcinoma to the paranasal sinuses is a rare clinical entity. We present a 75-year-old male patient who presented with swelling of the forehead and left upper eyelid with proptosis in left eye due to metastasis from lung adenocarcinoma. It appears as a puffy swelling of the forehead like a Pott's puffy tumor. Pott's puffy tumor is a subperiostal abscess of the frontal bone associated with osteomyelitis and usually occurs as a complication of sinusitis or trauma.Öğe Obstructive hydrocephalus caused by giant basilar artery aneurysm(RIYADH ARMED FORCES HOSPITAL, 2013) Kaptan, Hülagu; Köktekir, Ender; Reçber, Fahri; Akdemir, GökhanGiant basilar artery aneurysms are rarely associated with hydrocephalus. When it occurs the treatment usually addresses the hydrocephalus rather than the aneurysm itself, especially if it is already thrombosed. The treatment options include ventriculoperitoneal shunting and endoscopic third ventriculostomy, which may be related to high complication rates. However, reducing the intracranial hypertension may produce aneurysmal growth. We report a patient with obstructive hydrocephalus due to thrombosed giant basilar artery aneurysm. The patient initially presented with symptoms of increased intracranial pressure, and was managed by ventriculoperitoneal shunting with significant symptomatic improvement. Fifteen days after operation, the patient died due to a cerebrovascular event. We report a case that deteriorated because of cerebral infarction due to aneurysmal growth after ventriculoperitoneal shunting. We also discuss the treatment options in such cases.Öğe Resolution of papilledema after endoscopic third ventriculostomy versus cerebrospinal fluid shunting in hydrocephalus: a comparative study Clinical article(AMER ASSOC NEUROLOGICAL SURGEONS, 2014) Köktekir, Ender; Köktekir, Bengü Ekinci; Karabağlı, Hakan; Gedik, Şansal; Akdemir, GökhanObject. In this study the authors compare the efficacy of endoscopic third ventriculostomy (ETV) versus CSF shunting for resolution of papilledema in hydrocephalus. Methods. This comparative case series study recruited 12 patients (24 eyes) with hydrocephalus who underwent either an ETV (Group 1, 6 patients [12 eyes]) or CSF shunt treatment (Group 2, 6 patients [12 eyes]). A complete ophthalmological examination including retinal nerve fiber layer (RNFL) evaluation by optical coherence tomography was provided for all patients before surgery and in the 1st week, 1st month, and 3rd month postoperatively. The 2 groups were compared for quantitative changes in RNFL thickness and, thereby, resolution of papilledema. Statistical evaluation was performed using the Mann-Whitney U-test with the aid of SPSS version 16.0. Results. The mean preoperative RNFL thickness was 259.7 +/- 35.8 mu m in Group 1 and 244.5 +/- 53.4 mu m in Group 2 (p = 0.798). The mean decrease in RNFL thickness was 101.3 +/- 38.8 mu m, 141.2 +/- 34.6 mu m, and 162.0 +/- 35.9 mu m in Group 1 versus 97.0 +/- 44.6 mu m, 143 +/- 45.6 mu m, and 130.0 +/- 59.8 mu m in Group 2 for the postoperative 1st week, 1st month, and 3rd month, respectively. There was no significant difference between the two groups with respect to decrease in RNFL thickness during the 1st week, 1st month, and 3rd month (p = 0.563, p = 0.753, and p = 0.528, respectively). Conclusions. This is the first study to quantitatively evaluate papilledema in assessing the success of ETV and CSF shunting. The authors' results indicated that ETV is as effective as CSF shunting with respect to decreasing intracranial pressure and resolution of papilledema.Öğe Small cell lung carcinoma metastasis to atypical meningioma: ımportance of perfusion magnetic resonance ımaging graphics in differential diagnosis(ELSEVIER SCIENCE INC, 2019) Danisman, Mehmet Cagri; Koplay, Mustafa; Paksoy, Yahya; Keleşoğlu, Kazım Serhan; Karabağlı, Pınar; Köktekir, EnderWe described the imaging findings of small cell lung carcinoma metastasis to atypical meningioma and the importance of magnetic resonance imaging perfusion graphics at the differential diagnosis. To be able to determine subtypes of meningiomas and differentiate whether they are malignant or benign may provide a preoperative idea to determine prognosis and surgical procedure.Öğe Symptomatic Pneumorrhachis(THIEME MEDICAL PUBL INC, 2014) Köktekir, Ender; Tatarlı, Necati; Ceylan, Davut; Köktekir, Bengü Ekinci; Akdemir, GökhanPneumorrhachis (PR) is the presence of air within the spinal canal, whether localized in the epidural or in the subarachnoid space. Evidence of intraspinal air, especially in the subarachnoid space, had been thought to be merely a radiological artifact of serious underlying pathology until it was proven that PRs can be related to neurologic symptoms ranging from radicular pain to serious neurologic deficits. The etiologies, pathomechanisms, and natural courses show differences from case to case, with the result that no consistent treatment strategies exist in the literature. Although the conservative treatment modalities seem to be more appropriate in nonsymptomatic cases, treatment strategies in symptomatic cases remain the subject of discussion. In this study, we present two symptomatic cases of PR arising from different causes and review the literature, focusing especially on the symptomatic cases and strategies for treating them.Öğe Travma sonrası kafa kemiğinde nekrotik yara ilişkili kronik osteomyelit: Olgu sunumu(2013) Sümer, Şua; Karameşe, Mehtap; Köktekir, Ender; Ural, OnurOtuziki yaşında erkek hasta acil servise sağ temporoparietal alanda 4x11 cm doku defekti ile getirildi. Beyin tomografisinde sağ parietal alanda doku defekti görüldü fakat kemik doku bütünlüğü korunmaktaydı. Kraniyal kemiklerin korunması amacıyla serbest flep operasyonu yapıldı. Hastaneden taburcu olduktan 2 ay sonra nekrotik görünümde kirli akıntılı yara ile başvurdu. Tomografide temporoparietal alanda kemik defekti görüldü. Ampirik antibiyotik tedavisi başlandı. İlk aşamada nekrotik dokular debride edilerek granülasyon dokusu oluşumu için hasta izlendi. Doku ve kemik kültüründe Pseudomonas aeruginosa üremesi saptandı. Patoloji sonuçları kronik osteomiyelit ile uyumlu geldi. Granülasyon dokusu gelişiminden sonra skalpten rotasyon flebi yapıldı. Hastanın antibiyotik tedavisi 6 haftaya tamamlandı. Altı hafta sonrasında 3 boyutlu tomografi görüntülemelerinde osteoblastik aktivite ve kemik oluşumu görüldü.Öğe An Unusual Mechanism of Delayed Intracerebral Hemorrhage After Ventriculoperitoneal Shunting: Case Report(JOURNAL NEUROLOGICAL SCIENCES, 2012) Köktekir, Ender; Tatarlı, Necati; Ceylan, Davut; Karabağlı, Hakan; Akdemir, GökhanWe present a case of delayed intracerebral hemorrhage that developed seven years after initial ventriculoperitoneal shunt surgery. A seven-year-old boy was admitted to emergency when he experienced sudden headache and vomiting. Computed tomography (CT) scanning showed an intracerebral hemorrhage around the ventricular catheter that cannot be explained by known predisposing factors such as head trauma, coexisting bleeding disorder, occult vascular malformation, and intratumoral hemorrhage. The presumed mechanism in this case is that the ventricular catheter caused contusion of cerebral tissue because the shunt tube at the neck had stretched during the growing up of the child.Öğe Vascular Silicone Injection of Fresh Cadaveric Cow Cranium: Alternative Training Model For The Human Brain(2015) Tatarlı, Necati; Süslü, Hikmet Turan; Ceylan, Davut; Şeker, Aşkın; Karabağlı, Hakan; Köktekir, Ender; Özdoğan, SelçukArka plan: İnsan beyin damar sisteminin anatomik ve fizyolojik farklılıkları, arteriyel ve venöz sistemlerin silikon enjeksiyonu ile görülebilir. Yeni bir yöntem olarak, taze inek kranium kadavrasının silikon injeksiyonu, mikroanatomik çalışmalar için insan beyninin silikon enjeksiyonuna bir alternatiftir. Amaç: Amacımız, silikon enjeksiyon tekniği kullanarak taze inek kranium kadavrasının renkli silikon enjeksiyonu için geliştirilmiş bir metot bildirmektir. Yöntem: İnsan beynine alternatif olarak mikroanatomik diseksiyonlarda kullanmak üzere beş adet taze inek kraniumu, injekte edildi. Hazırlık, majör damarların yıkanması ve renkli silikon injeksiyonunu içerir. Sırasıyla internal karotis arter ve internal juguler venlerin kateterle kanülasyonu, ana arter ve venlerin su ile yıkanması, kraniumun alkol veya formaldehit ile fikse edilmesi, kırmızı ve mavi silikon ile arter ve venlerin renkli injeksiyonu uygulandı. Bulgular: Silikon injeksiyonları, taze inek kranium kadavrasında, küçük beyin damarlarının ve mezenkimal yapıların içine renkli solüsyonların derin penetrasyonunu sağladı. İnjeksiyon yapılmış beş kraniumun dördünde başarılı olundu. Birinde ise suboptimal sonuçlara varıldı. Sonuç: Mikroanatomik çalışmalar için kraniumun damarlarının anatomik ve fizyolojik değerlendirilmesi temelinde, silikon injekte edilmiş inek kranium kadavrası, insan beyin kadavrasına bir alternatif olarak önerilmiştir.
