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Öğe Ali el-Atvel Karabaş Velî ve Risâletü'd-Deverân'ı(Selçuk Üniversitesi Sosyal Bilimler Enstitüsü, 2004) Keskin, Fatih; Toprak, SüleymanÖğe 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 Comparison of Synthetic Dura and Autologous Dura in Terms of Complication Development in Children Aged 0-1 Years Who Underwent Surgery for Meningocele and Myelomeningocele(Selçuk Üniversitesi, 2023 Ağustos) İzci, Emir Kaan; Keskin, Fatih; Araç, DenselAim: The aim of this study is to compare the usage of synthetic and autologous dura mater in terms of complication risk in 0-1-year-old children who were operated for meningocele and myelomeningocele. Materials and Methods: This cross-sectional observational study was conducted with 44 children aged 0-1 years who were operated for meningocele and myelomeningocele in a university hospital neurosurgery clinic between November 2010 and December 2016. Patient data were extracted retrospectively from hospital records. The demographics and gestational and clinical features of the mothers and babies, and the need for secondary surgery and the presence of postoperative infection, necrosis, wound dehiscence, and/or neurological deficit were compared between the cases in whose surgery synthetic dura mater was used and the cases in whose surgery autologous dura was used. Findings: In total, 86.4% of the 44 infants were preterm, and the predominant neurological problem was plegia in the vast majority. While the defect was located in the lumbar region in more than half of them, myelomeningocele was detected in 77.3% of all cases. The median defect size detected in the patients was 20.0 cm2. Primary closure was performed in 30 patients, limberg flap procedure in 14 patients, however, autologous dura mater and synthetic dura mater were used equally in the patients. The defect size was larger in patients using synthetic dura, furthermore, hydrocephalus was found more frequently in these patients. While primary closure was applied in all patients using autologous dura and in one third of the patients using synthetic dura. Limberg flap procedure was applied in two thirds of synthetic dura group. The need for secondary surgery developed more frequently in synthetic dura group, and all postoperative complications were observed more frequently in these patients. In addition, the need for secondary surgery and postoperative necrosis, wound dehiscence, and neurologic deficit were more frequent in patients who underwent Limber flap compared to primary closure. However, the need for secondary surgery and the risk of postoperative complications were similar between primary closure and Limberg flap procedures in synthetic dura group. Conclusion: Although the synthetic dura mater was used in more severe patients, it had a higher need for secondary surgery and a higher risk of complications compared to autologous dura. In patients using synthetic dura, on the other hand, primary closure and Limberg flap had similar efficacy and safety.Öğe Comparison of the Effects of an Adhesion Barrier and Chitin on Experimental Epidural Fibrosis(TURKISH NEUROSURGICAL SOC, 2010) Keskin, Fatih; Esen, HasanAIM: Epidural fibrosis is an important factor for postoperative failed back syndrome development and causes clinical complaints in 6-25% of cases. An effective treatment modality has not been found yet. The aim of this study is to investigate the anti-adhesive effects of a novel agent chitin and compare these effects with a popular adhesion barrier collagen matrix. MATERIAL and METHODS: 21 rabbits were allocated into three groups including 7 rabbits each. L5 total laminectomy was performed to all groups. No treatment was given to Group 1 (Control group). Collagen matrix was used in Group 2 and chitin was used in Group 3. Six weeks later all rabbits were sacrificed and the laminectomy areas were entirely resected and investigated histopathologically. RESULTS: He and Revel grade III epidural fibrosis was detected in the control group. Statistically significant reduction of epidural fibrosis was achieved with both of the anti-adhesive agents, collagen matrix and chitin, when compared with the control group (p<0.05). The results were not different between treatment groups (p>0.05). CONCLUSION: The novel agent chitin was found effective for preventing epidural fibrosis and this effect was not significantly different from the collagen matrix. In light of our findings we suggest that chitin is an effective alternative for adhesion barriers.Öğe Deneysel epidural fibroziste adezyon bariyerleri ile chıtın'in etkisinin karşılaştırılması(Selçuk Üniversitesi Tıp Fakültesi, 2008) Keskin, Fatih; Baysefer, AlperTavşanlarda oluşturulan deneysel epidural fibrozis sonrası adezyon bariyerleri ile chitin'in etkisini karşılaştırmak için yapılan deneysel çalışmada 4 farklı grupta toplam 28 adet tavşan kullanıldı. Deneklere ketamin ve ksilazin anestezisi altında L5 total laminektomi uygulandı. I. grup kontrol grubu olup laminektomi sahasına herhangi bir madde konulmadı. II. grup laminektomi sahasına duragen plus, III. grup laminektomi sahasına Adcon-L, IV. grup laminektomi sahasına chitin koyulan grup olarak belirlendi. Bütün denekler 6 hafta sonra sakrifiye edildi. Alınan kesitler ışık mikroskobu altında histopatolojik olarak incelendi ve gruplar arası karşılaştırma yapıldı. Çalışmamızda kontrol grubunda ortalama grade 3 fibrozis bulundu ve diğer gruplar arasında istatiksel olarak anlamlı fark tespit ettik (p<0,05). Grup 2,3,4 kendi arasında epidural fibrozisi önlemek açısından istatisksel olarak anlamlı fark tespit edilmedi. Sonuç olarak kullanılan tüm maddeler postoperatif epidural fibrozisi azaltmaktadır. Yeni bir ürün olan chitin'in adezyon bariyerleri arasında bir seçenek olabileceği kanaatine varıldı. Ancak bu sonuçların kliniğe uygulanabilirliği açısından daha ayrıntılı ve ileri çalışmalara ihtiyaç vardır.Öğe Dural Carotico-Cavernous Fistula: Pre and Postembolization Appearances of Bone-Subtracted CT Angiography(TURKISH NEUROSURGICAL SOC, 2013) Koc, Osman; Genc, Emine; Ozturk, Banu; Genc, Bulent Oguz; Keskin, Fatih; Ozbek, OrhanDigital subtraction angiography (DSA) is the best method of evaluating carotid cavernous fistulas (CCF). DSA, however, has the disadvantage of being an invasive procedure. Computerized tomography (CT) angiography which is noninvasive, have been shown to provide more information about the size and location of fistulas. As a new method, Bone-Subtraction CT Angiography (BSCTA), than conventional CT angiography, is a method that improves the detection and interpretation of vascular lesions near to the cavernous segment of carotid artery. In this case report, we report a case of a dural carotico-cavernous fistula (CCF), appearances of pre and postembolization BSCTA images, confirmed by on DSA. As far as we know, CCF demonstrated by BSCTA has not been reported yet.Öğe Enfekte Lumbosakral Spinal Dermoid Kist(2010) Kalkan, Erdal; Erdi, Fatih; Keskin, Fatih; Kaya, Bülent; İlik, Kemal; Karataş, YaşarAmaç: Bu olgu sunumun amacı nadir görülen ve tanıda karışıklığa sebep olabilecek intradural yerleşimli enfekte olmuş bir dermoid kist olgusu sunmaktır. Olgu sunumu: Beş aylık kız bebek, belinde hassasiyet ve kızarıklık oluşturan şişlik ve iltihabi akıntı şikayetleri ile başvurdu. Lumbosakral bölgede eritemli, ısı artışı olan şişlik mevcut olup, şişliğin ortasındaki cilt lezyonundan iltihabi akıntı oluşmakta idi. Manyetik rezonans görüntülemesinde L3- S1 arasında uzanım gösteren; hiperintens, heterojen, intradural yerleşimli, spinal kordda ekspansiyona yol açan kitle lezyonu tespit edildi. Hasta opere edilerek L3-4 total laminektomi ile abse drenajı, traktus ve subtotal kitle eksizyonu uygulandı. Eksize edilen tümöral dokunun histopatolojik incelemesinde kistik dermoid tümör tanısına ulaşıldı. Abseye yönelik antibiyotik tedavisi düzenlenen hasta tedavisi tamamlandıktan sonra önerilerle taburcu edildi. Sonuç: Dermoid tümörler nadir görülen spinal tümörlerdir. Genellikle yavaş ve asemptomatik seyrederlerken araya giren enfeksiyon ya da tümöral kistin rüptürü gibi nedenlerle akut ve bazen geri dönüşümsüz tehlikeli sonuçlara neden olabilirler. Bu olgu sunumu ile özellikle pediatrik çağda görülen spinal kitlelerin ayırıcı tanısında dermoid tümörlerin akılda tutulması ve bunlarda görülebilen enfeksiyon ve rüptür riski göz önüne alınarak uygun zamanda cerrahi tedavi planlanması gerekliliği hatırlatılmak istenmektedir.Öğe Gibboziteye Neden Olan ve Tedavi Altında Farklı Seviyede Reaktivasyon Gösteren Pott Hastalığı(2010) Kalkan, Erdal; Erdi, Fatih; Keskin, Fatih; İlik, Kemal; Karataş, YaşarAmaç: Pott Hastalığı; Mycobacterium tuberculosis'in neden olduğu vertebral osteomyelit olarak tanımlanmaktadır. Bu yazıda gibboziteye neden olan ve tedavi altında farklı seviyede reaktive olan Pott Hastalığı bulunan bir olgu sunulmaktadır. Olgu sunumu: Otuz iki yaşında bayan hasta sırt ağrısı şikayeti ile kliniğimize başvurdu. Hastanın torakal manyetik rezonans görüntülemesinde (MRG) Th 6-7 vertebra osteomyeliti tespit edildi. Hasta opere edildi. Sol anterolateral yaklaşımla Th5-6 abse drenajı, korpektomi ve anterior stabilizasyonfüzyon uygulandı. Hastanın ameliyat sonrasında sırt ağrısı şikayeti düzeldi. Histopatolojik ve mikrobiyolojik inceleme sonuçları tüberküloz olarak rapor edildi. Anti tüberküloz tedavisi başlandı. İlk ameliyattan 3 ay sonra hasta bel ağrısı ve yürümede güçlük şikayetleri ile tekrar kliniğimize başvurdu. Hastanın bu sürede önerilen anti tüberküloz ilaçlarını düzenli bir şekilde aldığı öğrenildi. Çekilen MRG’de lomber vertebra osteomyeliti tespit edildi. Hasta tekrar opere edilerek anterior yaklaşımla L2 vertebral abse drenajı, korpektomi, diskektomi uygulanıp anterior stabilizasyon ve füzyon uygulandı. Sonuç: Son yıllarda tüm dünyada ve ülkemizde tüberküloz olgularında artış kaydedilmektedir. Omurga tüberkülozu iskelet sistemi tüberkülozları içerisinde en sık görülen tip olup hastalık günlük nöroşirurji pratiğinde tekrar gündeme gelmeye başlamıştır.Öğe Intradural Intramedullary Conus Medullaris Metastasis of Colorectal Adenocarcinoma: A Case Report(Ege University Press, 2012) Keskin, Fatih; Kalkan, Erdal; Erdi, Mehmet Fatih; Esen, HasanSpinal cord metastasis is rarely seen. Intramedullary spinal metastasis has been defined between the rates of 0,9 -2,1% in the autopsies performed on the cancerous cases. And also intramedullary spinal metastases are defined at a rate of 8,5% in the cases which have metastasis at central nervous system. The male patient, who was at the age of 62, was admitted to our clinic with the complaints of serious back and left leg pain and weakness at the left leg which had begun 15 days before. Low anterior resection + total mesorectal excision + ileostomy were applied to the patient five years ago due to colorectal adenocarcinoma. The carcinoma was reported as adenocarcinoma grade II. Chemotherapy and radiotherapy were applied after postoperative period. Left SLR was positive and 3/5 monoparesis at left leg was determined in the patients neurological examination. Conus medullaris located tumor was determined in the magnetic resonance imaging of the patient. Intradural intramedullary tumor which was infiltrated to the conus medullaris was totally removed with microneurosurgical technique via Th12-L1-2 total laminectomy. Th11-L3 posterior instrumentation and fusion were added because of expansive laminectomy and L1 corpus involvement of the tumor. The histopathological examination was reported as colorectal adenocarcinoma metastasis. In this manuscript we report a colorectal adenocarcinoma metastasis to the conus medullaris for the first time in the literature.Öğe Radiofrequency ablation of a rare pathology: vertebral intraosseous lipoma(ELSEVIER SCIENCE INC, 2016) Ozbek, Orhan; Keskin, Fatih; Kaya, Hasan Emin; Guler, Ibrahim; Nayman, Alaaddin; Koc, Osman[Abstract not Available]Öğe Radiological anatomy of the C7 vertebra: Clinical implications in spine surgery(WOLTERS KLUWER MEDKNOW PUBLICATIONS, 2015) Keskin, Fatih; Erdi, Fatih; Nayman, Alaaddin; Babaoglu, Ozan; Erdal, Kalkan; Ozer, Ali FahirContext: This study was designed to understand and define the special radio-anatomic morphometry of C7 vertebra by using multidetector computed tomography (MDCT). Aims: The major aim of the study was to detect the gender- and side-related morphometric differences of C7 vertebra among subjects. Setting and design: Our radiology unit database scanned for MDCT sections of the C7 vertebra. Materials and Methods: A total of 214 patients (134 men, 80 women) were selected. A detailed morphometric evaluation of C7 was done. Statistical analysis used: T test, ANOVA. Lamina length (P < 0.001), pedicle length (P < 0.001), outer cortical (P = 0.01) and inner cancellous pedicle (P < 0.001) width, pedicle angle to sagittal plane (P < 0.001) values were statistically significantly different on the right versus left side. When the results were stratified by gender, lamina length, inner cancellous lamina height, pedicle length, inner cancellous pedicle height, outer cortical pedicle width, lateral mass anteroposterior length, anteroposterior length of C7 corpus, height of C7 corpus (P < 0.001), C6-7 (P = 0.013) and C7-T1disc height (P = 0.04), transverse foramina perpendicular width at C7 (P = 0.046) values were found to be statistically significantly different. Vertebral artery most commonly enters into the transverse foramina at C6 level. Conclusions: Gender and side differences are important factors for preoperative planning and showed significant differences among subjects. MDCT is a practical option for investigating the exact anatomical features of osseous structures.Öğe Recurrence of Primary Spinal Cyst Hydatid in a HIV (+) Patient: A Case Report(JOURNAL NEUROLOGICAL SCIENCES, 2013) Keskin, Fatih; Erdi, Fatih; Kalkan, Erdal; Karatas, YasarHuman immunodeficiency virus and cyst hydatid association is a very rare condition. A 30-year-old male patient was operated for spinal cyst hydatid in our clinic previously. A year after first surgery the patient was readmitted to our clinic with recurrence of spinal cyst hydatid in a different spinal level. In this report we present this uncommon association and discuss the cause of recurrence.
