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    Influence of Prior Lumbosacral Surgery on The Incidence of Intravascular Injection During Transforaminal Epidural Injections
    (JOURNAL NEUROLOGICAL SCIENCES, 2015) Suslu, Husnu; Suslu, Hikmet Turan; Tatarli, Necati; Ceylan, Davut; Guclu, Bulent; Karabagli, Hakan
    Objective: Percutaneous lumbar transforaminal epidural steroid injections are frequently used to treat low back pain. However, many reports have indicated that this procedure has a high risk of morbidity. The aim of this study was to determine the difference in the incidence of vascular penetration during lumbosacral transforaminal epidural injections between patients with previous lumbar spinal surgery and patients who did not undergo surgery. Design: This is a prospective clinical study. Methods: In this study, patients who received lumbar transforaminal epidural injections at an outpatient spine center were included and followed. An interventional spine physician observed fluoroscopically guided lumbosacral transforaminal epidural steroid injections under live fluoroscopy and recorded contrast patterns. A total of 296 fluoroscopically guided lumbosacral transforaminal epidural steroid injections under live fluoroscopy in 108 patients were evaluated. Results: The incidence of vascular contrast patterns was observed under live fluoroscopy. Vascular injections were observed in 28 of the 296 injections, for an overall incidence of 9.5%. The incidence of intravascular injections among patients was 40.0% (20/50) in the previously operated group and 13.8% (8/58) in the non-operated group. This difference was statistically significant (p<0.001). A secondary analysis was performed to determine if the other factors affected the success of the procedure or increased the incidence of vascular injections. Conclusion: Our results indicated that previous surgery affected intravascular dissemination and increased the risk of vascular injection. Cohesional area caused by previous surgery complicated the injection. Additionally, fluoroscopy count and operation time were also affected by previous surgery.
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    Vascular Silicone Injection of Fresh Cadaveric Cow Cranium: Alternative Training Model For The Human Brain
    (JOURNAL NEUROLOGICAL SCIENCES, 2015) Tatarli, Necati; Suslu, Hikmet Turan; Ceylan, Davut; Seker, Askin; Karabagli, Hakan; Koktekir, Ender; Ozdogan, Selcuk
    Background: Anatomical and physiological variations of the human brain's vascular system can be observed via silicone injection of the arterial and venous systems. As a novel method, the injection of a fresh cadaveric cow cranium with silicone is an alternative to using the human brain for microanatomical studies. Objective: To report on an improved method for the colored silicone injection of a fresh cadaveric cow cranium using a silicone injection technique. Methods: Five fresh cow crania were injected as an alternative to human brains for microanatomical dissection, in which the preparation consisted of the irrigation of the major vessels and the injection of colored silicone. Cannulation of the internal carotid arteries and the internal jugular veins with catheters was performed, and the vasculature was irrigated with water (major arteries and veins). The fixation of the specimen with either formaldehyde or alcohol, and the colored injection of the arteries and veins with red and blue silicone, respectively, was then performed. Results: The silicone injections resulted in the deeper penetration of the colored solutions into the small cerebral vessels and mesenchymal structures of the fresh cadaveric cow crania. Of the five injected specimens, four exhibited successful injections, while one had suboptimal results. Conclusion: Silicone injection of the cadaveric cow brain, based on the anatomical and physiological assessment of the vasculature of the specimen for microanatomical studies, is suggested as an alternative to using human brain specimens.