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Öğe Can facet joint infiltrative analgesia reduce postoperative pain in degenerative lumbar disc surgery?(Soc Espanola Neurocirugia, 2008) Bademci, G.; Basar, H.; Sahin, S.; Ozcakir, S.; Anbarci, H.; Evliyaoglu, C.; Keskil, S.Objective. Perioperative analgesia effects the postoperative course of pain. The purpose of this study was to evaluate its possible relation with the consumption of dolantine and analgesics and the facet-induced pain and postoperative pain score in degenerative disc surgery. Methods. We employed perioperative intra- and perifacet bupivacaine infiltration technique to reduce the postoperative pain after lumbar disc surgery. The study was randomized and observer blinded enrolling 40 American Society of Anesthesiologists physical status class I-II patients scheduled for elective degenerative lumbar disc surgery. The patients were divided into two groups of 20 of which Group 1 underwent injection of bupivacaine into the subcutaneous and muscular layers around the incision site, while Group 2 underwent additional intra- and perifacetal joint infiltration. Postoperatively, the patients were provided with a programmed patient-controlled pump which was only activated on demand to infuse dolantine for the next 24 hours. In the postanesthesia care unit the delay for analgesia and the dose of dolantine used were recorded. Results. There was no statistical significance between these two groups regarding postoperative visual analoque scale scores. The time before the first analgesic request was significantly longer in facet group (p = 0,006). The cumulative dolantine dose was also significantly lower in the facet group (p = 0,001). Conclusion. The results indicate that facet joint infiltrative analgesia may have an effect on the postoperative analgesic requirement and reduce the dolantine consumption.Öğe First illustrations of female "Neurosurgeons" in the fifteenth century by Serefeddin Sabuncuoglu(Sociedad Luso-Espanola Neurocirugia, 2006) Bademci, G.Males have dominated medicine for many centuries. Females could not appear in the medical history equally till the end of the 18(th) century; although they always have been in medicine as healers. It is worth mentioning that first illustrations indicating female surgeons were found in the book written in Turkish by Serefeddin Sabuncuoglu in the 15(th) century; while Europe was newly waking up from its dark ages and Middle East was under the influence of strict rules of Arabic and Islamic culture. Serefeddin Sabuncuoglu (1385-1470) was the author of the first illustrated surgical textbook Cerrahiyyetu'l-Haniyye (Imperial surgery) in Turkish Literature.Öğe Late dissemination of ependymoma: case report(Soc Espanola Neurocirugia, 2007) Bademci, G.; Tun, K.; Erden, E.; Evliyaoglu, C.; Unlu, A.Spinal cord dissemination over 10 years after surgical removal of the fourth ventricle ependymoma without local recurrence is extremely rare. A 49-year-old male underwent a macroscopically gross total removal of the fourth ventricle ependymoma and postoperative radiothe rapy to the posterior fossa. Twelve years after the initial operation, the patient complained from uncontrolled fever attacks, low back pain and numbness of the legs. Spinal Magnetic Resonance Imaging revealed intradural extramedullary mass lesions located at the thoracic 2-3 and lumbar 5 vertebrae levels. Cerebrospinal fluid exami nation showed no tumour cells. He underwent total excision of these spinal lesions. Although the majority of the recurrences take place within a few years after surgery, we experienced a case with multiple spinal disseminations 12 years after the resection of the fourth ventricle ependymoma and administration of the radiation therapy to the posterior fossa. Up to our knowledge, this case represents the second unusual late recurrence reported in the literature. We conclude that low grade ependymomas should be followed neurologically and radiologically for more than 10 years after the initial treatment.Öğe The morphometric and cephalometric study of anterior cranial landmarks for surgery(Georg Thieme Verlag Kg, 2008) Kazkayasi, M.; Batay, F.; Bademci, G.; Bengi, O.; Tekdemir, I.Objective: The aim of this work was to determine reliable bony landmarks for the anterior skull base and to standardize some specific dimensions among the frontal sinus and neighboring structures for safe anterior cranial surgery. Methods: The study consisted of a topographical anatomic examination and cephalometric analysis of the skull. Thirty adult skulls (60 sides) were studied regarding the localization and dimensions of the supraorbital foramen (SOF), frontal sinus (FS), frontozygomatic fissure, infraorbital foramen, anterior nasal spine, and nasion. Differences between the measurement of skulls and cephalograms were analyzed by Student's t test. The Pearson correlation test was used for statistical analysis of the cephalogram. Results: Examination of the 60 sides of the bony heads revealed that the shape of the SOF was a foramen in 25 sides (41%), a notch in 29 sides (49%), and a groove in 6 sides (10%). A total of 20 (33%) SOFs were inside the FS and the mean distance was 6.3 + 1.34 mm from the lateral border of the sinus, 27 (45%) of SOFs were outside of the FS and the mean distance was 8.8 + 2.01 mm, and 13 (22%) of SOFs were at the border of the FS. According to our measurements the medial border of the craniotomy should be placed approximately 43 mm lateral to the nasion to avoid entering into the frontal sinus. Conclusion: To plan and to decide the convenient and safe anterior midline skull base approach and to avoid postoperative complications, bony landmarks and anatomic measurements around the SOF and FS will be helpful for the surgeon to constitute a simplification of topographic anatomy.Öğe Persistent metopic suture can mimic the skull fractures in the emergency setting?(Soc Espanola Neurocirugia, 2007) Bademci, G.; Kendi, T.; Agalar, F.Metopism is partially or totally persisting suture extending from the nasion to the anterior angle of the bregma. The time of physiological closure of the metopic suture varies from birth to 8 years of age. Widely accepted closuring time is approximated at 2 years of age. Although formerly reported skull studies mentioned the persistent metopic suture, it is extremely rare in clinical practice. We presented a trauma case of 43 years of age who was demonstrated radiologically to have a persisting suture. Persistent metopic suture may be misdiagnosed as a vertical traumatic skull fracture extending in the mid-line in head trauma patients. Therefore the surgeon should be aware of this anatomical condition in the primary and secondary surveillance of the traumatized patient and during surgical intervention including especially frontal craniotomy. Reconstructed tomography scan demonstrating sutural closuring status may provide additional informative value in the diagnostic sequence superior to plain X-ray in the emergency setting.Öğe Posterior communicating artery: From microsurgical, endoscopic and radiological perspective(Georg Thieme Verlag Kg, 2005) Avcı, E.; Bademci, G.; Öztürk, A.Objective: The main objective of this study was to display the morphological characteristics of the posterior communicating artery and its perforating branches in various configurations of the circle of Willis and their relationship with neighbouring anatomic structures by microscopic examination of the brain hemispheres and endoscopic examination of cadaver specimens. A secondary aim was to investigate the possibility of detecting the posterior communicating artery and its variations in cerebral MR angiographies performed for various reasons. Methods: The posterior communicating artery was examined under the microscope in 24 cerebral hemisphere specimens, by endoscopy in 5 cadavers and by 3D TOF MRI in 62 patients. Results: The posterior communicating artery had a hypoplastic configuration in 28%, whereas it was transitional in 14%, fetal in 28% and adult in 30% of cerebral hemisphere specimens. While no posterior communicating artery and transitional configuration could be detected in 11 % of the MR angiography examinations, 34 % had a hypoplastic configuration, 10% a fetal configuration and 45% an adult configuration. The percentage of infundibular dilatation was 22 % and the premamillary artery was the thickest perforating branch. The diameter of the posterior communicating artery varied between 0.5 and 3.03 mm. Discussion: A detailed knowledge on the variations of the posterior communicating artery and the morphological characteristics of the perforators arising from this artery in various configurations of the circle of Willis is an important factor affecting the results of surgical interventions.Öğe Tracing the dural tail with image-guided surgery(Georg Thieme Verlag Kg, 2006) Keskil, S.; Bademci, G.; Göksel, M.Objective: The extent of dural resection is important for preventing recurrence in meningioma management. An image-guidance assisted technique is described to perform adequate dural resection. Methods: A universal instrument adapter system for image-guidance was used to track the dural extension of the meningioma accurately. Results: The universal instrument adapter offers the surgeon the possibility to image-guide nearly any rigid instrument via the computed calibration method. in this way a surgical marking pen was used to chase and adequately mark the "dural tail". Discussion: Image-guidance systems can be used to avoid incomplete resection of the affected dura that may be responsible for tumour recurrence.Öğe "Triple cross" of the hypoglossal nerve and its microsurgical impact to entrapment disorders(Georg Thieme Verlag Kg, 2006) Bademci, G.; Batay, F.; Yaşargil, M. G.Objective: Cadaveric dissections were performed to review the intracranial and extracranial course of the hypoglossal nerve. The neurological significance of a newly defined "triple cross" of the hypoglossal nerve is discussed. Materials and Methods: 10 cadaveric heads (left and right; 20 sides) were dissected using microsurgical techniques. Results: In the cisternal segment of hypoglossal nerve, the diameter of the rostral trunk amounted to 155-680 mu m (mean 435 mu m), and the caudal trunk to 210-820 mu m (mean 482 mu m). The roots formed three trunks in 20% of the hypoglossal nerves and two trunks in the rest. As a first cross, the anterior medullary segment of the vertebral artery crossed the hypoglossal nerve roots in 14 of 20 sides (70%). As a rare variation, the vertebral artery extended medial to the nerve (25%) or between its roots (5%). The second cross was found between the descendens hypoglossus and the occipital artery (75%), sternocleidomastoid artery and vein complex (15%) and external carotid artery (10%). The third cross was shown in the submandibular triangle between the lingual hypoglossus and its drainage vein; vena committans nervus hypoglossus. Conclusion: Throughout its way, the hypoglossal nerve passes over vascular structures in three crossing points which may serve as a probable cause of hypoglossal nerve entrapment disorders.
