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    The extradural subtemporal keyhole approach to the sphenocavernous region: Anatomic considerations
    (GEORG THIEME VERLAG KG, 2003) Kocaogullar, Y; Avci, E; Fossett, D; Caputy, A
    Fourteen cadaver specimens (28 sides) and twelve dry human skulls (24 sides) were used to study the anatomic relationships between bony, neurovascular and foraminal landmarks in the floor of the middle fossa in preparation for performing the extradural subtemporal keyhole approach to the sphenocavernous region. The interforaminal distance was largest between the foramina rotundum (FR) and ovale (FO) and was smallest between the FO and foramen spinosum (FS). The largest angle between exit foramen was the FIR to FO. The greater superficial petrosal nerve (GSPN) was always found to overlie and run parallel to the petrous internal carotid artery, however, its location over the artery and its separation from it by bone was variable. With a subtemporal "keyhole" placed above the posterior zygomatic root (PZR), a 0degrees endoscope allowed easy visualization of the middle meningeal artery (MMA) and the mandibular nerve (V-3) however, a 30degrees endoscope was more useful for visualizing the maxillary nerve (V-2) and the ophthalmic nerve (V-2). With a sphenoidotomy performed between V-1 and V-2, the 30degrees endoscope was found to be the most useful for visualizing the carotid siphon and the contralateral wall of the sphenoid sinus, while the 70degrees endoscope was the most useful for visualizing of the floor of the Sella and the walls of the sphenoid sinus. Two venous concerns with respect to performing endoscopic approaches to the region were identified: a fibrous layer overlies a heavy venous plexus that encircles the petrous carotid artery, and the foramen Vesalius, which transmits a large emissary vein draining the cavernous sinus, was identified medial to the FO in 30% of our dissected sides.
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    Iatrogenic epidermal inclusion cyst of the parapharyngeal space: Unusual complication of ear surgery
    (THIEME MEDICAL PUBL INC, 2004) Ulku, CH; Uyar, Y; Kocaogullar, Y; Avunduk, MC
    A 46-year-old man presented with a 12-month history of a slow-growing mass at the right anterior temporal and superior parotid region. He had a history of chronic otitis media and had undergone a modified radical mastoidectomy for cholesteatoma 5 years earlier. Physical examination revealed a sinus tract and diffuse soft tissue mass measuring 4 cm in diameter spread throughout the region of the right anterior temporal and superior parotid areas. Magnetic resonance imaging (MRI) showed three separate masses, including contrast material in the right superior parotid region and lateral skull base. The patient underwent a preauricular infratemporal approach. Six months later, a sinus tract recurred at the inferior border of the right zygomatic arch. MRI showed multiple masses in the right prestyloid parapharyngeal space, which were resected through a transparotid approach. The histopathologic diagnosis was an epidermal inclusion cyst (EIC). One year after the operation the patient was in good health and there was no sign of disease. EICs are rare tumors that are seen when epidermal elements are included in the dermis, which can follow trauma. EICs are unusual in the parapharyngeal space. Thus, until they become clinically observable, primary benign growths may not be recognized in this region. EICs must be considered in the differential diagnosis of growths in the parapharyngeal space, particularly among patients with a prior history of tympanomastoid surgery on the tumor side.
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    The role of hyperbaric oxygen in the management of subarachnoid hemorrhage
    (SPRINGER, 2004) Kocaogullar, Y; Ustun, ME; Avci, E; Karabacakoglu, A; Fossett, D
    Objective: To determine the role of hyperoxic and hyperbaric therapy following experimental subarachnoid hemorrhage (SAH). Design: Prospective, randomized, controlled animal study. Subjects: Thirty male Wistar rats. Interventions: Thirty rats were assessed for an initial neurologic status as double-blinded by two different neurosurgeons using a neurologic severity score (NSS) and then underwent an initial angiographic examination. Two days later, 0.3 ml of homologous blood was injected into the cisterna magna to produce a SAH-induced cerebral vasospasm. The NSS and angiographic examination were then repeated. The rats having no spasm or a spasm under 50% (n=8) and 50% or over 50% (n=22) were grouped separately, as groups 1 and 2, respectively. The rats having 50% or more spasm were further divided randomly into group 2A and 2B. The rats in groups 1 and 2A (n= 11) underwent a 60-min course of 100% oxygen at the atmospheric pressure 1 atmosphere absolute (ata), and group 2B (n= 11) received 100% oxygen at 3 ata for I h. Neurologic assessment was repeated on the next day and 7 days later. Measurements and main results: The animals having no spasm or less than 50% spasm had a better NSS and outcome when compared with the animals having 50% or more spasm. But the animals with 50% or more spasm which underwent hyperbaric therapy were shown to have a better outcome compared to the animals having hyperoxic therapy. Conclusion: Exposure to hyperbaric oxygen therapy seemed to accelerate the recovery of neurologic deficits secondary to experimental SAH.