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Öğe First detailed description of axial traction techniques by Serefeddin Sabuncuoglu in the 15th century(Springer, 2005) Bademci, Gülşah; Batay, Funda; Sabuncuoğlu, Hakan…Öğe Glabellar frown lines as a reliable landmark for the supratrochlear artery(SAGE Publications Inc., 2000) Vural, Emre ; Batay, Funda; Key, J. MichaelOBJECTIVE: Preservation of the supratrochlear vascular pedicle (SVP) during use of the paramedian forehead flap can be accomplished by the aid of Doppler imaging; however, a reliable surface landmark may be invaluable in cases where Doppler examination fails. Our observations showed that the most prominent glabellar frown lines (GFLs) are very close to the SVP; however, the actual relationship of these structures remains unclear. STUDY DESIGN: The relationship between GFLs and the SVP was investigated in 19 volunteers by the aid of Doppler imaging and in 8 cadaver heads by dissection. The distance between the GFLs and the SVP was measured. SETTING: The study took place at an academic tertiary-care facility. RESULTS: The SVP was located just at the GFLs in almost 50% of the cases and an average of 3.2 mm lateral to GFLs in the remaining cases. CONCLUSION: GFLs may serve as reliable surface landmarks in the use of the paramedian forehead flap where Doppler imaging was not helpful.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 The morphometric and cephalometric study of anterior cranial landmarks for surgery(Georg Thieme Verlag Kg, 2008) Kazkayası, Mustafa; Batay, Funda ; Bademci, Gülşah; Bengi, Osman; 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 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 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 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 Selective microsurgical vestibular neurectomy: An option in the treatment of intractable vertigo and related microsurgical landmarks(Georg Thieme Verlag Kg, 2004) Bademci, Gülşah; Batay, Funda; Yorulmaz, İrfan; Küçük, Bacur; Çağlar, ŞükrüSelective microsurgical vestibular neurectomy (SMVN) is an accepted and effective means of treating patients with intractable vertigo, a resistant component of Meniere's syndrome. Meniere's syndrome is a condition characterized by fluctuating hearing loss, tinnitus and serious vertigo attacks. Vertigo is the most disabling symptom of the disease. There may be permanent hearing loss in untreated cases and vertigo may continue after deafness. Selective microsurgical vestibular neurectomy is an elite surgical procedure providing exact relief from vertigo while protecting the preoperative hearing level. In this report, clinical results of nine patients with intractable vertigo operated in the University of Ankara Medical Faculty, Department of Neurosurgery between 1999 and 2001 are discussed. Accordingly, we aimed to represent the landmarks often required for microsurgical exposure. From this study we conclude that SMVN is an effective neurosurgical procedure for those patients who are resistant for medical treatment and require hearing preservation.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.
