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Öğe Ceftriaxone-induced symptomatic pseudolithiasis mimicking ICP elevation(Johann Ambrosius Barth Verlag Medizinverlage Heidelberg Gmbh, 2005) Evliyaoğlu, Çetin; Kizartici, T; Bademci, Gülşah; Ünal, B; Keskil, SIn neurosurgery, ceftriaxone is a widely used, third generation cephalosporin for the treatment of CNS infections and perioperational prophylaxis. Recent studies have demonstrated that ceftriaxone induces reversible precipitates in the gallbladder. This complication is referred to as '' biliary pseudolithiasis '', and it has symptoms similar to the raised intracranial pressure (ICP) symptoms of the perioperative period. Symptomatic biliary pseudolithiasis should be kept in mind in all pediatric neurosurgery cases under ceftriaxone therapy in order to prevent unnecessary postoperative investigations and surgery.Öğe Cerebral MRI findings in neonatal hypoglycemia(2005) Bademci, Gülşah; Yücel, Engin; Aliefendioglu, DidemMetabolic disturbances such as anoxia and hypoglycemia may adversely alter the development of the neonatal brain. While rapid and appropriate diagnosis with adequate therapy has a good prognosis; delayed detection and/or inappropriate therapy increases the risk of the development of irreversible brain damage. Magnetic resonance imaging (MRI) studies are essential in neonatal hypoglycemia to define the characteristics and severity of cerebral lesions after hypoglycemia, to decide the efficacy of preferred treatment modality and to predict the neurologic outcome. Although acute and long-term radiologic abnormalities associated with hypoglycemic episodes in children and adults are well documented, the details of the situation for neonatal hypoglycemia are still emerging. In this review, the impact of MRI findings of neonatal hypoglycemia on diagnosis, monitoring of treatment and neurologic outcome was discussed. © 2005 - IOS Press and the authors. All rights reserved.Öğe Clinical experiences in neuronavigation(Ortadogu Ad Pres & Publ Co, 2007) Bademci, Gülşah; Berdan, Fatoş; Evliyaoğlu, Çetin; Keskil, SemihObjective: To evaluate the introduction of a neuronavigation system to our neurosurgical department as an increasingly important part of both planning and performing intracranial surgery. Material and Methods: From February 2005 to August 2006, 17 cranial neurosurgical operations with the aid of the Medtronic neuronavigation system were performed in the Department of Neurosurgery, Faculty of Medicine, University of Kirikkale. Duration of procedures, accuracy of targeting and processing the lesions, craniotomy spaces, duration of hospital stay, and postoperative neurologic status were evaluated. Results: Neuronavigation assisted operations accounted for 6.2% of elective surgeries in the selected time period. The mean deviation form accuracy for registration was 2.7 mm. Deep-seated small lesions comprised UP of the cases operated with neuronavigation assistance (33.3%). Although the duration of procedures and the duration of hospital stay seemed slightly higher for nueronavigation in comparison to the standard procedures it is more effective in the selection of the best position for the surgical approach, it reduces the time required for skin incision and craniotomy planning and cortex incision. Conclusion: Integration of high technology modalities to neurosurgery is becoming an increasingly used feature and provides useful information during surgery especially in small and multiple brain tumors located in eloquent brain areas.Öğe First detailed description of axial traction techniques by Serefeddin Sabuncuoglu in the 15th century(Springer, 2005) Bademci, Gülşah; Batay, Funda; Sabuncuoğlu, Hakan…Öğe Intracranial hemorrhage due to vitamin K deficiency in ınfancy: Clinical and radiological findings(2009) Mısırlıoğlu, Emine Dibek; Aliefendioğlu, Didem; Bademci, Gülşah; Baydar, Zekiye; Köse, Gülşen; Çakmak, Fatma NurBu çalışmada; K vitamini eksikliğine bağlı intrakraniyal kanaması olan 25 infantın klinik, radyolojik bulguları ve risk faktörleri geriye dönük olarak değerlendirildi. 25 olgunun 2 (%8)'si klasik tip ve 23'ü geç başlangıçlı tipte idi. 18 (%72)'i erkek ve 7 (%28)'si kız idi. Olguların 24 (%96)'ü sadece anne sütü ile beslenmekteydi. Olguların 18'ine doğumdan sonra K vitamini uygulanmıştı. En fazla görülen semptom kusma (%44) ve konvülsiyon (%40) idi. En fazla saptanan muayene bulgusu fontanel bombeliği (%40) ve solukluk (%40) idi. Onbir (%44) hastada intrakraniyal kanama birden fazla bölgede vardı ve kanama en fazla (%68) intraparankimal alana olmuştu. 12 olgu izleminde normal mental-motor gelişim gösterirken, mortalite oranı %8 bulundu. İntrakraniyal kanama özellikle geç tipin bulgusu olup en fazla intraparankimal alanda olmaktadır. Anne sütü ile beslenen bebeklerde doğumdan sonra K vitaminin yapılmamış olması en önemli risk faktörüdür.Öğe Microsurgical anatomical landmarks associated with high bifurcation carotid artery surgery and related to hypoglossal nerve(Karger, 2005) Bademci, Gülşah; Batay, Funda; Vural, Emre; Avci, Emel; Al-Mefty, Ossama; Yasargil, M. Gazi…Öğe Microsurgical anatomy of the hypoglossal nerve(Churchill Livingstone, 2006) Bademci, Gülşah; Yaşargil, M. GaziThe aim of the present study was to review the surgical anatomy of the hypoglossal nerve (HN), to reveal its relationships on its course and to provide some landmarks to its identification. Ten cadaveric head dissections (20 sides) were performed using microsurgical techniques. The anatomical relationships between the HN and other nerves, muscles, arteries and veins were carefully recorded, and some measurements were made between the HN and related structures. Thus, various landmarks were determined for the easy identification of the HN. In addition, the hypoglossal triangle, which containes major vascular structures, is described. The HN is divided into three main parts: cisternal. intracanalicular and extracranial. The HN arises from the medulla as a line of rootlets situated along the anterior margin of the lower two-thirds of the olive in the preolivary sulcus. It is the newly described 'hypoglossal' triangle in the anterior neck that is bordered by the descending hypoglossus laterally, transverse hypoglossus inferiorly and inferior border of the stylohyoid muscle superiorly. In our specimens, we determined that the HN was 3-7 mm (mean 5 mm) inferior to the digastric tendon, as well as mostly superficial. The occipital artery arose from the posterior surface of the external carotid artery (ECA) 6-9 mm (mean 7 mm) above the carotid bifurcation. There is also an important 'cross' between the occipital artery and the HN. In all cadavers, this crossing point was 7-9 mm (mean 8 mm) superior to the emergence of the occipital artery from the ECA. In conclusion, understanding the detailed anatomy of the HN and using landmarks to identify the nerve are crucial for surgery in the region. (c) 2006 Elsevier Ltd. All rights reserved.Öğe Microsurgical landmarks for safe removal of anterior clinoid process(Georg Thieme Verlag Kg, 2005) Avcı, Emel; Bademci, Gülşah; Öztürk, AdilObjective: The microsurgical and radiological anatomy of the clinoid process were studied to give surgeons more details about the anterior clinoid process and its relations to the vascular and nervous neighbourhood during intradural and extradural clinoidectomy, thus making the operative procedures safer. Methods: Seven formalin-fixed (14 sides) and two fresh cadavers (four sides) were studied to reveal the surgical anatomy of the anterior clinoid process and related landmarks during intradural and extradural drilling techniques of clinoid process. Furthermore, aeration of the anterior clinoid process was investigated in 100 paranasal tomography (200 sides) scans. Results: Careful drilling of the anterior clinoid process is mandatory to avoid damage to the extremely important adjacent structures. The anterior clinoid process must not be removed in one piece. Clinoid folds and the frontotemporal fold should be exposed adequately. The falciform ligament must be cut to visualize the optic nerve and ophthalmic artery clearly. Preoperative radiological assessment of clinoid process variations should be done. In computerized tomography scans, pneurnatization of the right anterior clinoid process was found in 12%, of the left anterior clinoid process in 7% and bilaterally pneurnatization was present in 9%. Conclusions: Removal of the ACP is one of the most critical procedures to the successful and safe management of ophthalmic segment aneurysms and tumors located in the paraclinoid region and cavernous sinus. Special attention should be paid to the anatomic landmarks indicating the relationship between the anterior clinoid process and adjacent structures. Beside that, pneumatization of the anterior clinoid process should be evaluated preoperatively with computed tomography to avoid complications such as rhinorrhea and pneumocephalus.Öğe Molecular genetic analysis of two large kindreds with intracranial aneurysms demonstrates linkage to 11q24-25 and 14q23-31(Lippincott Williams & Wilkins, 2006) Öztürk, Ali K.; Nahed, BV; Bydon, M; Bilguvar, Kaya; Göksu, Ethem; Bademci, Gülşah; Günel, MuratBackground and Purpose - Both environmental and genetic factors contribute to the formation, growth, and rupture of intracranial aneurysms (IAs). To search for IA susceptibility genes, we took an outlier approach, using parametric genome-wide linkage analysis in extended IA kindreds in which IA is inherited as a simple Mendelian trait. We hereby present the molecular genetic analysis of 2 such families. Methods - For genome-wide linkage analysis, we used a 2-stage approach. First, using gene chips in affected-only analysis, we identified genomic regions that provide maximum theoretical logarithm of odds (lod) scores. Next, to confirm or exclude these candidate loci, we genotyped all available family members, both affected and unaffected, using polymorphic microsatellite markers located within these regions. Results - We obtained significant lod scores of 4.3 and 3.00 for linkage to chromosomes 11q24-25 and 14q23-31, respectively. Conclusions - Molecular genetic analysis of 2 large IA kindreds confirms linkage to chromosome 11q and 14q, which were suggested to contain IA susceptibility genes in a previous study of Japanese sib pairs. Independent identification of these 2 loci strongly suggests that IA susceptibility genes lie within these regions. While demonstrating the genetic heterogeneity of IA, these results are also an important step toward cloning IA genes and ultimately understanding its pathophysiology.Öğe Non-traumatic elevation techniques of the hypoglossal nerve during carotid endarterectomy: A cadaveric study(Georg Thieme Verlag Kg, 2005) Bademci, Gülşah; Batay, Funda; Tascioğlu, A. O.Objective: Ligation and dissection techniques of sternocleidomastoid artery, vein, ansa cervicalis and posterior belly of digastric muscle were developed in a cadaveric study for achieving minimally invasive elevation of the hypoglossal nerve during carotid endarterectomy and were subsequently used in patient treatment. Methods: Carotid bifurcations, the extracranial part of the hypoglossal nerve, the sternocleidomastoid artery and vein and neighboring neurovascular structures were studied on 10 formalin-fixed adult cadaver heads (20 sides) under the surgical microscope. Landmarks and measurements for identification of the sternocleidomastoid artery and vein are described. Results: The distance between the hypoglossal loop and the carotid bifurcation was measured as 14.5-25.2mm (mean: 19.24 mm). 30 of 20 sides were determined to have a Zone II-type carotid bifurcation. In 33 % of the Zone-II-type bifurcations, a low-lying hypoglossal loop was demonstrated. The sternocleidomastoid artery begins 2.2 - 3.5 mm (mean: 2.94 mm) supero-posterior from the occipital artery after the crossing point between the occipital artery and the hypoglossal nerve. The sternocleidomastoid artery and vein complex was 17.1 +/- 21.5 mm (mean 18.47 mm) away from the carotid bifurcation and forms a right angle with the descending hypoglossal nerve. The contribution of the sternocleidomastoid branch of the occipital artery always reaches the middle parts of the sternocleidomastoid muscle. Conclusion: Carotid endarterectomy through having knowledge of the normal and variable trajectories of the Structures can almost always be accomplished as a safe procedure when appropriate maneuvers are applied. Dissection and ligation of the sternocleidomastoid artery, vein, ansa cervicalis and posterior belly of digastric muscle are very simple but effective techniques to obtain adequate exposure either for safe arterial reconstruction or to diminish the necessity for more complicated technical procedures.Öğe Pitfalls in the management of Cushing's disease(Churchill Livingstone, 2007) Bademci, GülşahCushing's disease is caused by functional corticotroph adenomas of the pituitary gland, most commonly noninvasive microadenomas. Transsphenoidal microsurgery is an effective means of control for patients with adrenocorticotrophic hormone-producing microadenomas. However, a wide variation of clinical outcomes and recurrence rates has been reported. The major causes of surgical failure in the treatment of Cushing's disease lies in inadequate preoperative evaluation, unsuccessful identification of the adenoma and inexperience of the surgeon. Furthermore, appropriate use of combination therapy, including surgery, radiotherapy, radiosurgery and adrenalectomy can improve the outcome. For optimal results in this rare disease, endocrinological, radiological and surgical procedures should be co-ordinated in a specialized center. In this review, factors affecting preoperative evaluation, surgical success and outcome are outlined in the light of current knowledge. (C) 2006 Elsevier Ltd. All rights reserved.Öğe Pott's puffy tumor of the vertex years after trauma in a diabetic patient: case report(Sociedad Luso-Espanola Neurocirugia, 2005) Evliyaoğlu, Çetin; Bademci, Gülşah; Yücel, Engin; Keskil, SemihPott's puffy tumor is a rare clinical entity characterized by subperiosteal abscess associated with osteomyelitis. It is usually seen as a complication of frontal sinusitis or trauma. This is the unique report of a Pott's puffy tumor located over the vertex of a type 1 diabetic patient with an unusual latency of 14 years following injury. A 27-year old man presented with pain and a soft swelling on his vertex. Magnetic resonance imaging demonstrated subperiosteal abscess in the vertex region associated with dural thickening and perisinusal irregularities of epidural space. Further history revealed that he had a trauma to the same location when he was 13 years old. Considering possible complications due to proximity of the lesion to the sagittal sinus, we retrained from aggressive surgical interventions. We treated our patient with a simple surgical abscess drainage followed by prolonged use of antibiotics and achieved complete therapy. The cellular and humoral elements of the immune system may be disrupted in diabetic patients resulting in such atypical courses and complications of infections. We want to emphasize both importance of the prompt diagnosis of Pott's puffy tumor as intracranial invasion may cause severe neurologic problems, and importance of a surgical intervention tailored for the individual lesion.Öğe Prevalence of primary tethered cord syndrome associated with occult spinal dysraphism in primary school children in Turkey(Karger, 2006) Bademci, Gülşah; Saygun, Meral; Batay, Funda; Çakmak, Aytul; Basar, Halil; Anbarci, Hüseyin; Ünal, BirsenThe prevalence and associated factors of primary tethered cord syndrome (PTCS) in primary school children were investigated. A cross-sectional study was performed in four demographically different primary schools in Turkey. Demographic, familial and physical data were collected from 5,499 children based on enuresis as a predominant symptom and dermatologic and orthopedic signs as clues of occult spinal dysraphism. Statistical analysis and input of the data were carried out with the SPSS package program 10.00, and logistic regression analysis was used to identify discriminating factors between enuretic children with or without neurologic signs. Of 5,499 analyzed children, 422 (7.7%) had enuresis nocturna, and 19.9% of 422 children had also daytime incontinence. Sixteen of these 422 enuretic children (3.8%) had several dermatologic signs. Five of them had spina bifida on plain radiographies, and 4 of them had cord tethering on lumbar MRI. Fifteen of 422 enuretic children (3.7%) had gait disturbances and orthopedic anomalies without cutaneous manifestations. Six of 15 children had spina bifida on plain graphies and 2 of them had tethered cord syndrome on MRI. The general prevalence of PTCS was found to be 0.1% of 5,499 analyzed children and 1.4% of enuretic children. A good outcome after untethering was found in 83.0% in this series. Practitioners should be aware of these clues of occult spinal dysraphism and resort to further radiologic and neurosurgical assessment. Early surgical intervention may halt the progression of the neurologic deficits and stabilize or reverse symptoms. Copyright (c) 2006 S. Karger AG, Basel.Öğe Proximally situated osseous septum in complex spina bifida - Case report(Amer Assoc Neurological Surgeons, 2005) Bademci, Gülşah; Evliyaoğlu, Çetin; Keskil, SemihIn Type I split cord malformation (SCM) lesions, the osteocartilaginous spur and its dural sleeve are almost always located in the caudal extent of the median cleft. The authors present a case of lumbar myelomeningocele associated with a thoracic Type I SCM in which an osseous septum is uniquely situated in the proximal extent of the median cleft. Split cord malformations are cord-tethering lesions, which may be associated with a myelomeningocele that causes additional tethering, even in the opposite direction; therefore, both lesions should be treated. In view of this unique case, however, the surgical approach used for tethering lesions in such cases of complex spina bifida should perhaps be tailored. Whenever feasible, meticulous preoperative examination of a patient with spina bifida, including entire craniospinal magnetic resonance imaging followed with perioperative dynamic evaluation, is important for the effectiveness and safety of the surgery.Öğe Risky anatomic variations of sphenoid sinus for surgery(Springer, 2006) Ünal, Birsen; Bademci, Gülşah; Bilgili, Yasemin K.; Batay, Funda; Avcı, EmelWe searched for the surgically risky anatomic variations of sphenoid sinus and aimed to compare axial and coronal tomography in detection of these variations. Fifty-six paranasal tomography images (112 sides) were evaluated for coronal, axial and both coronal and axial images. Tomographic findings including bony septum extending to optic canal or internal carotid artery; protrusions and dehiscences of the walls of internal carotid artery, optic nerve, maxillary nerve and vidian nerve; extreme medial course of internal carotid artery; patterns of aeration of the anterior clinoid process; and Onodi cells were evaluated. The results were classified as "present, absent, suspicious-thin (only for dehiscence) or no-consensus". The results of each plane were compared with that of the result of the both planes together. Kappa coefficient and Chi-square tests were used to compare both planes. Twelve cadaveric dissections were performed to reveal the proximity of sphenoid sinus to surgically risky anatomic structures. Endoscopy was applied to five cadavers. 18 evaluations were classified as 'no-consensus'. We detected 34, 35, 34 and 40 protrusions of internal carotid artery, optic nerve, maxillary nerve, vidian nerve, respectively. Dehiscences were present in 6, 9, 4 and 8, and suspicious-thin in 8, 10, 16 and 25 in canals of internal carotid artery, optic nerve, maxillary nerve and vidian nerve, respectively. Bony septum to internal carotid artery and optic nerve was observed in 30 and 22 cases. We observed 9 extreme medial courses of internal carotid artery, 27 aerated clinoid process and 9 Onodi cells. Axial images were superior in detection of bony septum to internal carotid artery and Onodi cells; while the coronal images were more successful in detection of protrusion of optic nerve and vidian nerve, and dehiscense of maxillary nerve and vidian nerve (P < 0.05). In cadaveric dissections, the septa were inserted into the bony covering of the carotid arteries in two sinuses (8.3%). Detailed preoperative analysis of the anatomy of the sphenoid sinus and its boundaries is crucial in facilitating entry to the pituitary fossa and reducing intraoperative complications. Coronal tomography more successfully detects the sphenoid sinus anatomic variations.Öğe VACTERL-H associated with central hypothyroidism: A case report(Medecine Et Hygiene, 2007) Aliefendioğlu, Didem; Bademci, Gülşah; Keskil, S.; Somuncu, Salih; Mısırlıoğlu, E.; Çakmak, Ahmet MuratVACTERL-H associated with central hypothyroidism: A case report: The VACTERL-14 syndrome is a rare combination of vertebral anomalies, anal atresia, congenital heart defects, tracheo-esophageal fistula, abnormalities of kidneys and limb anomalies together with hydrocephalus. This condition is recognized as a hereditary entity with poor prognosis. We present a newborn weighing 3400 g, born by cesarean section to a 27 years old mother who had had an irregular antenatal follow-up. The patient had severe hydrocephalus, proximal esophageal atresia and distal tracheoesophageal fistula, gastric outlet obstruction, imperforated anus and recto-urethral fistula, patent ductus arterious, a bifid scrotum, a vertebral defect, sacral dimple and central hypothyroidism. The patient had no limb defects. The association of central hypothyroidism and VACTER-L-H has previously not been reported.Öğe Yaşlılarda ağrılı osteoporotik vertebra çökme kırıklarının tedavisinde kifoplasti-vertebroplasti etkinliğinin değerlendirilmesi(2005) Bademci, Gülşah; Aydın, Zafer; Batay, Funda; Attar, Ayhan; Çağlar, Yusuf ŞükrüAmaç: Konservatif tedaviden fayda görmeyen ağrılı osteoporotik vertebra çökme kırıklı yaşlı hastaların vertebroplasti ve kifoplasti ile tedavi edilerek, beklenen morbidite ve mortaliteden korunmaları ve yaşam kalitelerinin arttırılması amaçlanmıştır. Gereç ve Yöntem: Ankara Üniversitesi Tıp Fakültesi Nöroşirürji Anabilim Dalında 2003-2004 yılları arasında, ağrılı osteoporotik vertebra çökme kırığı olan dokuz yaşlı hastaya (iki erkek, yedi kadın, 60 yaş üzeri) kifoplasti ve vertebroplasti uygulanmıştır. Yöntemlerin etkinliği, klinik ve radyografik olarak değerlendirilmiştir. Sonuçlar: Osteoporotik vertebra kırıkları, serimizde kadınlarda daha yüksek oranda bulunmuştur. Tüm hastalar osteopenik veya osteoporotiktir ve dirençli ağrı en belirgin semptomdur. İlaç tedavisine ve fizik tedaviye yanıt vermemişlerdir. Torakolomber vertebroplasti ve kifoplasti uygulanan dokuz hastadan sadece birinde klinik olarak önemsiz epidural kaçak gelişmiştir. Tüm hastaların şikayetlerinde akut düzelme izlenmiş, radyografik olarak da %88.8’inde postoperatif vertebra elevasyonu sağlanmıştır. Seride mortalite ve morbidite yoktur. Tüm hastalar aynı gün mobilize edilmiş ve ilk üç gün içinde taburcu edilmişlerdir. Tartışma: Osteoporotik vertebra kompresyon kırıkları, yaşlılarda önemli bozukluklara ve mortaliteye yol açar. Bu kırıkların cerrahi tedavisinde, hastanın ağrısını en aza indirmek, kifozu önlemek ve daha iyi yaşam koşullarını minimal invaziv bir yolla gerçekleştirmek hedeflenmelidir.
